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J B Puylaert

Publications and source records attributed to J B Puylaert.

At least 19 recordsLinked to original sources
PubMed2004

[Spontaneous rupture of the bladder].

A spontaneous bladder rupture was diagnosed using ultrasound and CT scan in 3 patients, 1 woman aged 62 and 2 men aged 77 and 42, presenting with abdominal pain, anuria and prior problems with urination. The younger man had suffered from this previously; he was now suffering from bacterial peritonitis due to infected urine. All 3 patients recovered after treatment with a transurethral catheter and antibiotics. A transurethral resection was performed on the benign enlarged prostate of the older man. The combination of non-specific symptoms, the absence of trauma history and its very rare occurrence mean that initially a spontaneous bladder rupture may not be suspected. However, an untreated bladder rupture can lead to life-threatening situations. Screening the abdomen with ultrasound, an ultrasound-guided puncture and CT scan may yield results that suggest a bladder rupture. In most cases, conservative treatment with a transurethral catheter will be sufficient. Sometimes surgical repair of a bladder rupture may be necessary.

Adult↗
PubMed2003

[Epiploic appendagitis: an underestimated self-limiting acute abdominal condition].

OBJECTIVE: To describe the clinical findings in patients with epiploic appendagitis and to evaluate its natural course. DESIGN: Retrospective. METHOD: A review of the medical records was carried out for all patients who were diagnosed with epiploic appendagitis using ultrasonography and computed tomography (CT), during the period June 1988-October 2001, at the Haaglanden Medical Centre (Westeinde site), The Hague, the Netherlands. RESULTS: The study group consisted of 49 patients, 38 men and 11 women, with a median age of 41 years. The main symptom was focal abdominal pain, with a median diagnostic delay in the patients of 2 days, located in the left lower quadrant (n = 34), right lower quadrant (n = 8), right upper quadrant (n = 6) or left upper quadrant (n = 1) of the abdomen. No other complaints were present with the exception of nausea and vomiting in two patients. Leucocytosis was found in 21% of patients, the erythrocyte sedimentation rate was elevated in 26% of the patients, and signs of peritoneal irritation were found in 53% of the patients. Epiploic appendagitis was correctly included in the clinical differential diagnosis of 2 patients. All of the patients made a complete and uncomplicated recovery under conservative treatment; the majority were symptom-free within 9 days. CONCLUSION: Due to the increased use of diagnostic imaging in patients with acute abdominal symptoms, epiploic appendagitis is much more frequently diagnosed than before. Presenting symptoms of epiploic appendagitis are non-specific, leading to misdiagnosis in most cases. Epiploic appendagitis has a benign natural course and if patients are correctly diagnosed using ultrasonography and CT, unnecessary surgery and medical treatment may be avoided.

Abdomen, Acute↗
PubMed2001

Ultrasound of acute GI tract conditions.

Patients with acute abdominal pain are a great challenge to the radiologist. The clinical diagnosis is classically unreliable, resulting in both negative laparotomies as well as ill-advised surgical delay in a large number of patients. Ultrasound offers a non-invasive way to decrease both false-negative and false-positive diagnoses in this category of patients. This article focuses on the role of sonography in the diagnosis of acute conditions of the gastrointestinal tract tract such as appendicitis, sigmoid diverticulitis, Crohn's disease, colitis, infectious ileocecitis caused by Yersinia, Campylobacter or Salmonella, right-sided colonic diverticulitis, bowel malignancy presenting acutely, small bowel obstruction, intussusception, omental infarction, and epiploic appendagitis. The sonographic spectrum of these conditions as well as possible pitfalls are discussed using illustrative case histories.

Abdomen, Acute↗
PubMed2001

Epiploic appendagitis and omental infarction.

Epiploic appendagitis and omental infarction are benign self-limiting disorders. They are uncommon, though more common than is generally assumed. In both diseases the main clinical symptom is non-specific focal abdominal pain, with a normal or moderately raised white blood cell count and erythrocyte sedimentation rate. These findings often mimic an abdominal surgical emergency, which leads to clinical misdiagnosis of more common conditions such as appendicitis or diverticulitis. This may result in an unnecessary laparotomy. Ultrasonography (US) and computed tomography (CT) show characteristic features in most patients, allowing a secure non-operative diagnosis. Patients correctly diagnosed can avoid an operation or costly observation in hospital.

Abdomen, Acute↗
PubMed2000

[Enterovesical fistula in diverticulitis].

Three men aged 52, 60, and 38 years, complained of dysuria and recurrent cystitis. One patient mentioned pneumaturia, a feature which later appeared to be present in all three. Ultrasound examination showed air in the bladder, and demonstrated the fistulous tract in two cases. Computed tomography identified the third fistula. In all 3 the enterovesical fistula was a complication of sigmoid diverticulitis. After sigmoid resection they recovered well. The key to the diagnosis of enterovesical fistula is to think of it. Pneumaturia and faecaluria are pathognomonic symptoms. Both ultrasound and computed tomography may be helpful in the diagnosis.

Adult↗
PubMed2000

Spontaneously resolving appendicitis: frequency and natural history in 60 patients.

PURPOSE: To establish the frequency and natural history of ultrasonographically (US) documented spontaneously resolving appendicitis following conservative treatment. MATERIALS AND METHODS: From July 1987 to July 1997, the authors encountered 106 patients with US-diagnosed spontaneously resolving appendicitis. We retrospectively studied clinical data and US findings obtained at admission and follow-up relating to 60 patients who were treated conservatively. Over the same 10 years, 1,280 appendectomies for acute appendicitis were performed in the authors' hospital. RESULTS: Of 60 patients, 23 (38%) had recurrent appendicitis after a median of 14 weeks (range, 2-254 weeks), with 16 (70%) having recurrence within 1 year of the first attack. US findings indicated that patients with an appendiceal diameter of at least 8 mm were more prone to recurrence than patients with an appendiceal diameter of less than 8 mm; the recurrence rates were 47% (21 of 45 patients) and 13% (two of 15 patients). The other parameters did not show a statistically significant difference. CONCLUSION: Spontaneously resolving appendicitis occurs in at least one in 13 cases of appendicitis and has an overall recurrence rate of 38%, with the majority of cases reccurring within 1 year.

Acute Disease↗
PubMed1999

Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history.

Epiploic appendicitis and segmental omentum infarction are considered to be rare conditions, which may mimic an abdominal surgical emergency. The purpose of our study was to describe clinical findings, US and CT appearance of infarction of an epiploic appendage and omentum, and to determine their epidemiological characteristics and natural history. We retrospectively studied clinical, US and CT findings at hospital admission and follow-up of all patients who were diagnosed at our institution with epiploic appendicitis or omentum infarction between June 1988 and November 1997. We found a relatively high incidence of 40 cases: 20 patients with epiploic appendicitis, 11 with omentum infarction, and 9 in whom it was not possible to discriminate between the both. All 40 patients recovered under conservative treatment without complications. We conclude that US and CT features allow a reliable diagnosis, thereby obviating unnecessary surgery. Discriminating between both conditions is of no practical relevance since treatment and prognosis are identical.

Abdomen, Acute↗
PubMed1998

Right colonic diverticulitis: US and CT findings--new insights about frequency and natural history.

PURPOSE: To evaluate how the use of ultrasonography (US) and computed tomography (CT) has changed insights on the frequency and natural history of right colonic diverticulitis. MATERIALS AND METHODS: Clinical findings, US and CT images, and clinical and surgical records in 44 patients with a final diagnosis of right colonic diverticulitis seen over 11 years were retrospectively studied. RESULTS: Of the 44 patients, three underwent diverticulectomy, and 41 were successfully treated conservatively. Follow-up US demonstrated a consistent change in the pattern of the findings of diverticulitis over time, with eventual spontaneous evacuation of the contents of the inflamed diverticulum into the colonic lumen. Five patients had recurrent symptoms; two of them underwent elective surgery. The frequency of right colonic diverticulitis was one in 34 appendectomies, which is nine times higher than that reported to date. CONCLUSION: Right colonic diverticulitis is more common than has been previously reported. US and CT findings are characteristic and show a consistent pattern of changes over time. The natural history is benign, and surgical intervention can be avoided in the vast majority of patients.

Abdomen, Acute↗
PubMed1997

[Ovarian vein thrombosis].

A 44 year-old woman was admitted with fever and lower abdominal pain at the right side suggestive of appendicitis. Ovarian vein thrombosis was diagnosed by sonography and confirmed by contrast-enhanced CT scan. After heparinisation the complaints disappeared and fever resolved in less than 72 hours. Repeated radiological investigation showed regression of the thrombus. Ovarian vein thrombosis is an uncommon, potentially fatal disorder that can be adequately treated with medication. The cornerstone of the diagnosis consists in non-invasive radiological investigation.

Adult↗
PubMed1997

[Echographic recognition of tuberculous peritonitis].

OBJECTIVE: To assess the role of ultrasonography (US) and US-guided puncture in the diagnostic procedure of tuberculous peritonitis. DESIGN: Retrospective study. SETTING: An inner-city hospital: Westeinde Ziekenhuis, The Hague, the Netherlands. METHODS: Of 12 patients with bacteriologically confirmed tuberculous peritonitis diagnosed between 1987 and 1995, the results of ultrasonography and the bacteriological and cytological results of US-guided puncture were studied. RESULTS: The ultrasonographic appearance of wet tuberculous peritonitis was recognized by the radiologist in all 11 cases. There was loculated ascites with fine septations as well as thickening of peritoneum, mesentery and omentum. Ultrasonography was of no merit in the one case of peritonitis sicca in this study. US-guided puncture of ascites and omentum yielded a bacteriological diagnosis in eight patients, six of whom had a positive Ziehl-Neelsen or auramine test. In two other patients cytological examination showed a granulomatous inflammation. On average, the ultrasonographic diagnosis of wet tuberculous peritonitis was suggested 3 days after admission and bacteriologically confirmed 10 days later. Eleven of the 12 patients were immigrants from countries where tuberculosis is endemic. The mean duration of residency in the Netherlands was 7 years. CONCLUSION: Ultrasonography is valuable in the diagnostic procedure of tuberculous peritonitis in that it considerably reduces diagnostic delay and unnecessary surgical procedures are avoided.

Adolescent↗
PubMed1997

Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings.

Yersinia, Campylobacter, and Salmonella are pathological microorganisms which incidentally may specifically infect the ileocecal area (infectious ileocecitis). In such cases pain in the right lower quadrant is the predominant symptom, and diarrhea is absent or only mild. This symptomatology can lead to an unnecessary laparotomy for suspected appendicitis. At surgery a normal appendix is removed, while there is edematous thickening of ileum and cecum, and enlarged mesenteric lymph nodes. These ileocecal abnormalities give rise to a fairly characteristic US image, enabling the radiologist to rapidly differentiate infectious ileocecitis from appendicitis, thus preventing an unnecessary laparotomy. Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella is a common mimicker of appendicitis, and its incidence at this moment is grossly underestimated. Ultrasound is presently the only means to prevent an unnecessary operation for this condition which is principally self-limiting and innocuous.

Campylobacter Infections↗
PubMed1996

Appendicectomy.

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Appendectomy↗