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PubMedDate not supplied

Acute torsion and necrosis of the greater omentum herniated into a foramen of Morgagni.

Computed tomography is mandatory in the investigation of the acute abdomen and can provide the physician with crucial information to decide whether the patient should be treated surgically or conservatively. An unusual cause of acute abdomen is presented. Computed tomography suggested the diagnosis of omental torsion and necrosis. At surgery, the greater omentum and part of the transverse colon were incarcerated in a small diaphragmatic hernia of the Morgagni type.

Abdomen, Acute↗
PubMedDate not supplied

Lesser sac hernia through the gastrocolic ligament: CT diagnosis.

We present a case of a lesser sac hernia of the ileum through a defect in the gastrocolic ligament with reemergence through a defect in the gastrohepatic ligament. Computed tomography (CT) revealed the herniated bowel surrounded by the liver, the stomach and the pancreas, and demonstrated the defect in the gastrocolic ligament between the stomach and the transverse colon.

Hernia, Ventral↗
PubMedDate not supplied

CT findings in symptomatic left paraduodenal hernia.

Two cases of symptomatic, surgically proven left paraduodenal hernias were shown with computed tomography (CT) imaging. A small bowel loop was seen behind the pancreatic tail in one case, and a ring-oriented bowel loop was shown between the transverse colon and the left adrenal gland in the other.

Adult↗
PubMedDate not supplied

Pirenzepine versus scopolamine methyl bromide in double-contrast barium enema study of large bowel.

To evaluate the usefulness of pirenzepine for diagnostic double-contrast barium enema study of the large bowel, pirenzepine and scopolamine methyl bromide (SMB) were compared in a single, blind, randomized trial. Sixty consecutive patients were enrolled in the study. Quantitative analysis of bowel distention was done by measuring the maximum diameter of the transverse colon before and after drug administration. Four independent observers blindly evaluated distention and mucosal coating of the large bowel and global quality of the images. No differences were found in the diagnostic performance between the two drugs. However, pirenzepine induced a slight but significantly larger distention of the large bowel (68 +/- 12 vs. 65 +/- 8 mm, p = 0.02). Heart rate and rhythm during the study were recorded by ECG. SMB induced tachycardia in all patients (from 72 +/- 15 to 98 +/- 24 beats/min, p < 0.01), whereas pirenzepine did not (from 76 +/- 13 to 78 +/- 20, p = NS). After SMB, one-patient exhibited faintness, and some patients complained of visual accommodation defects, dryness of the mouth, and dizziness. Pirenzepine had a diagnostic performance similar to SMB in avoiding adverse effects elicited by SMB.

Adult↗
PubMed2000

Surgical strategy for large or malignant endocrine pancreatic tumors.

Endocrine pancreatic tumors (EPTs) are rare but have a remarkably better prognosis than adenocarcinoma of the pancreas. Patients with EPTs benefit from surgical and medical therapy, which may alleviate symptoms due to hormonal excess and increase survival. Patients with large or malignant EPTs with infiltrative disease may suffer from local complications, including gastrointestinal bleeding and obstruction and involvement of the superior mesenteric (SMV) and portal (PV) veins. Among 31 patients with operable and large or malignant EPTs, 7 had hormone-producing syndromes (insulin, glucagon), and 24 had clinically nonfunctioning EPTs. Surgery in these patients included vascular reconstruction of the SMV/PV (n = 4), resection of infiltrated adjacent organs (n = 5; stomach, transverse colon), or resection of concomitant liver metastases (n = 3). Four patients with conspicuously large insulinomas, and three with glucagonoma were successfully operated on with alleviation of hormonal symptoms. Among the 24 nonfunctioning EPTs, 5 patients had been explored earlier and their tumors judged inoperable due to locally invasive disease or misdiagnosis as pancreatic adenocarcinoma. The operations were performed with no mortality and low morbidity. We conclude that large and malignant EPTs with limited spread of disease may benefit from a combination of medical and surgical therapy.

Adult↗
PubMed1998

Chronic intussusception in childhood.

A rare case of chronic intussusception is reported. Radiological investigation including ultrasound, CT and barium enema provided the correct diagnosis. Ultrasound revealed a solid mass near the transverse colon in the right lower abdomen. CT demonstrated the real nature of the solid mass as being the classical 'coiled spring' of intussusception. The barium enema was unsuccessful as an attempt at hydrostatic reduction, but confirmed the diagnosis by a 'crescent-shaped' filling defect in the ascending colon. The patient was discharged after an uneventful surgery and recovery. No organic lesion that precipitated the chronic intussusception was discovered at operation. Radiological findings, the typical clinical picture and adequate treatment are discussed.

Chronic Disease↗
PubMed2000

Value of (18F)-FDG positron emission tomography, computed tomography, and magnetic resonance imaging in diagnosing primary and recurrent ovarian carcinoma.

The aim of this study was to compare prospectively the accuracy of whole-body positron emission tomography (PET), CT and MRI in diagnosing primary and recurrent ovarian cancer. Nineteen patients (age range 23-76 years) were recruited with suspicious ovarian lesions at presentation (n = 8) or follow-up for recurrence (n = 11). All patients were scheduled for laparotomy and histological confirmation. Whole-body PET with FDG, contrast-enhanced spiral CT of the abdomen, including the pelvis, and MRI of the entire abdomen were performed. Each imaging study was evaluated separately. Imaging findings were correlated with histopathological diagnosis. The sensitivity, specificity and accuracy for lesion characterization in patients with suspicious ovarian lesions (n = 7) were, respectively: 100, 67 and 86% for PET; 100, 67 and 86% for CT; and 100, 100 and 100% for MRI. For the diagnosis of recurrent disease (n = 10), PET had a sensitivity of 100%, specificity of 50% and accuracy of 90%. The PET technique was the only technique which correctly identified a single transverse colon metastasis. Results for CT were 40, 50 and 43%, and for MRI 86, 100 and 89%, respectively. No statistically significant difference was seen. Neither FDG PET nor CT nor MRI can replace surgery in the detection of microscopic peritoneal disease. No statistically significant difference was observed for the investigated imaging modalities with regard to lesion characterization or detection of recurrent disease; thus, the methods are permissible alternatives. The PET technique, however, has the drawback of less accurate spatial assignment of small lesions compared with CT and MRI.

Adult↗
PubMed2006

Splenic flexure volvulus in a child with chronic idiopathic intestinal pseudo-obstruction syndrome.

Splenic flexure volvulus in a child with chronic idiopathic intestinal pseudo-obstruction syndrome is extremely rare. Here we present a case report of this unusual condition in a 7-year-old girl. The splenic flexure volvulus was managed by pressure reduction from the cecal antegrade continence enema, after which elective resection of the splenic flexure and primary anastomosis were performed because she had similar attacks during 4 months after the first detorsion. Postoperatively she made an uneventful recovery. Possible factors of pathogenesis and therapeutic measures are discussed.

Biopsy↗
PubMed2000

Gastric teratoma in children.

Gastric teratoma (GT) comprises less than 1% of all teratomas in children. Though GT in the presence of immature neuroepithelial elements is regarded as malignant, the prognosis is excellent after complete excision of the tumor. Because of its rarity the world literature lacks a large study. Clinical experience with ten cases of GT is presented and discussed. Only one patient was female; the mean age at presentation was 3.2 months. Two cases were immature grade III GT; one of these had infiltrated the left lobe of the liver and the transverse colon while the other had metastasized to the regional lymph nodes and omentum. All the patients underwent complete excision. There were no deaths, and after a mean follow-up period of 4.2 years, all the patients had no recurrence and were healthy. Both the mature and immature types of GT have an excellent prognosis after complete excision of the tumor. Even when the immature type infiltrates surrounding structures, complete excision offers recurrence-free survival without requiring chemo- or radiotherapy.

Biopsy↗
PubMed1998

Traumatic injuries of the alimentary tract in children.

Traumatic alimentary tract (AT) perforations in children secondary to instrumentation, though rare, can occur at any age, especially in neonates and young infants. Awareness of such a possibility is essential for prompt management to be initiated. Over a 10-year period (1986-1995), eight pediatric patients with AT perforations secondary to instrumentation were managed at the American University of Beirut Medical Center. Five had upper AT injuries that included three hypopharyngeal, one esophageal, and one gastric lesion. The remaining three patients had lower AT injuries involving the transverse colon in one and the rectum in two. All the patients but two (one with a hypopharyngeal and one with an esophageal injury) were managed surgically and all survived. These rare injuries are discussed in addition to the preventive measures to be taken.

Esophageal Perforation↗
PubMed1998

Use of the appendix to replace the choledochus.

Ten cases of choledochal cyst (CC) were treated by biliary-appendicoduodenostomy. The follow-up comprised a patient interview, ultrasonography (US), and single-proton ejected computerized tomography (SPECT) scanning. In all cases an anti-reflux submucosal tunnel was added to the distal appendico-duodenostomy; all showed an uneventful postoperative course. All the dilated intrahepatic bile ducts had normalized on B-US postoperatively. Four children under went SPECT examination; all of them had patent neo-bile ducts. In the authors' opinion: (1) Anastomosing the cecal end of the appendix to the common hepatic duct seemed more favorable than the other way around, because the cecal end could be easily trimmed to the size of the common hepatic duct, which was more or less dilated in the presence of a CC; (2) It is necessary to add a submucosal tunnel to the distal appendicoduodenostomy to achieve a more reliable anti-reflux effect; and (3) Transposing the vascularized appendix through the retro-transverse colon simplified the procedure and might reduce the risk of retroperitoneal complications if bile leakage should occur.

Appendix↗
PubMed2002

Secondary omental torsion in children: report of two cases and review of the literature.

Torsion of the greater omentum (TGO) may be due to a congenital abnormal attachment of its free edge. There are no specific symptoms that allow a preoperative differential diagnosis of this condition from common pathologies such as acute appendicitis. Attachment of the omentum to the large bowel and the absence of concomitant diseases make it possible to distinguish TGO secondary to a congenital attachment anomaly from omental infarction, primary TGO, and TGO secondary to an acquired attachment anomaly (attachment to cysts, tumours, hernias, surgical scars, or perforated bowel segments). Resection of the ischaemic portion of the omentum permits complete resolution of the clinical symptoms. The authors report two cases of TGO in children due to abnormal attachment of the greater omentum to the ascending and transverse colon, respectively.

Adolescent↗
PubMed2003

Analysis of the therapeutic efficacy of different doses of budesonide in patients with active Crohn's ileocolitis depending on disease activity and localization.

BACKGROUND AND AIMS: The nonsystemic steroid budesonide has been used to treat active ileocecal and ileocolonic Crohn's disease (CD). This study investigated the optimal budesonide dose using a pH-dependent release formulation. The goal of treatment was the remission of CD (CDAI <150) within 6 weeks of treatment. PATIENTS AND METHODS: The study was of randomized, double-blind, dose-finding design. Patients with active CD ileocolitis without steroid pretreatment were treated with 3x2 mg ( n=39), 3x3 mg ( n=33), or 3x6 mg ( n=32) oral pH-modified released budesonide daily. RESULTS: The remission rates after 6 weeks were 36% with 3x2 mg, 55% with 3x3 mg, and 66% with 3x6 mg. Significantly more patients were in remission while treated with 3x6 mg than with 3x2 mg budesonide/day. Subgroup analyses revealed that patients with high disease activity (CDAI >/= 300) or ileocolonic disease with disease manifestation distal to the transverse colon responded better to the highest budesonide dose. CONCLUSION: Oral pH-modified released budesonide shows a dose-dependent effectiveness in patients with active ileocolonic CD. In the majority of patients 9 mg budesonide per day is sufficient. However, in patients with highly active disease or ileal disease with distal colonic manifestation higher doses of budesonide could increase the therapeutic response

Adult↗
PubMed1998

Primary non-Hodgkin lymphoma of the spine.

Primary non-Hodgkin lymphoma (PHL) occurs very rarely in bone. We report a case of a 63-year-old patient with PHL of the spine and an unusual postoperative complication leading to the development of a perforation of the transverse colon. After right hemicolectomy the patient recovered fully and was further treated with chemo- and radiotherapy. We emphasise the importance of an immunohistochemical analysis to exclude misdiagnosis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Crohn's disease mimicking as bowel endometriosis. Are the symptoms reduced by nafarelin acetate?

We report a 27-year-old female with Crohn's disease clinically misdiagnosed with intestinal endometriosis. Her complaints were abdominal pain and fullness, which occurred monthly during her menstrual period. Although we had no histopathological evidence, we diagnosed her as bowel endometriosis on the basis of her clinical course. Since nafarelin acetate therapy started, the symptoms due to mechanical subileus have improved. The transverse colon, a 70 cm segment of the ileum, including the terminal ileum, were resected because of repeated symptoms of bowel obstruction despite prolonged nafarelin therapy. Histopathological findings of the resected specimen revealed Crohn's disease without endometrial tissue. In our patient, an increased cortisol and ACTH secretion, a side effect of nafarelin, was noted during the therapy. This case showed that nafarelin therapy could increase serum concentration of ACTH and cortisol, which was considered to suppress the pathology of Crohn's disease by its anti-inflammatory action. We emphasize that intestinal examination must be performed with Crohn's disease in mind, even if nafarelin acetate is effective.

Adrenocorticotropic Hormone↗
PubMed2002

Emergency laparoscopic splenectomy for "wandering" (pelvic) spleen: case report and review of the literature on laparoscopic approach to splenic diseases.

Wandering spleen (WS) is a rare condition where the spleen, free from its ligaments, is allowed to move inside the abdomen predisposing the patient to life-threatening complications due to torsion of the vascular pedicle; splenic infarction, portal hypertension, bleeding and acute abdomen may occur. WS is rarely suspected at presentation since symptoms are usually not specific and definitive diagnosis is usually reached only by imaging technologies such as color flow ultrasonography and angio-spiral computer tomography. A 42-year-old woman was referred to our institute from the Emergency and Accident ward, complaining of a sudden onset of sharp abdominal pain together with nausea and vomiting. At examination a large, painful mass was present on the left middle-lower abdominal quadrant. A pelvic spleen was revealed at abdominal ultrasonography (US) and confirmed by abdominal CT. Emergency laparoscopy was carried out. The spleen was barely attached to the peritoneum of the anterior abdominal wall, covered by the greater omentum, the small bowel, and the transverse colon. Once mobilization of the spleen was concluded, the vascular pedicle appeared torted and thrombosed and laparoscopic splenectomy was performed. The patient was discharged on the 4th postoperative day with no complications. To date, only 5 cases of laparoscopic approach to WS have been reported. A review of the literature confirms that the reduction of postoperative stay, wound complications, and overall morbidity and a faster return to normal activity make laparoscopy the "gold standard" approach to the spleen as for treatment of many hematological disorders or more unusual splenic diseases.

Abdominal Pain↗
PubMed2004

A laparoscopic approach to the surgical management of enterocutaneous fistula in a wound healing by secondary intention.

Traditional surgical management of a chronic enterocutaneous fistula requires laparotomy, but the optimal site of incision is unclear. Laparoscopy and adhesiolysis may offer an alternative approach. Two cases of non-healing enterocutaneous fistula within chronic, granulating wounds are described. The laparoscope was placed subcostally using the Hasson technique with additional ports placed under direct vision. After clearing the anterior abdominal wall of all but the fistula-containing bowel, an incision was made circumferentially around the granulation bed. Resection and primary anastomosis was performed in standard fashion. Lateral component separation allowed primary wound closure. Both patients were discharged without sequelae and doing well at last follow-up (mean 12 months). A laparoscopic approach to non-healing enterocutaneous fistulas seems safe and technically feasible. When combined with lateral component separation, it may result in reduction of inadvertent enterotomies and optimal management of the wound without the use of prosthetic mesh.

Abdominal Wall↗
PubMed2006

Treatment of colorectal liver metastasis with biliary and portal vein tumor thrombi by hepatopancreatoduodenectomy.

We present a case of a large colorectal liver metastasis with portal vein and biliary tumor thrombi and duodenal and jejunal direct invasion that required hepatopancreatoduodenectomy. A 38-year-old woman presented to her local hospital with right back pain and jaundice. She had undergone transverse colectomy and limited liver resection for transverse colon cancer with a synchronous liver metastasis in September 1991, and low anterior resection for rectal carcinoma in January 1996. She was diagnosed as having colorectal liver metastasis and was referred to our hospital for possible surgery. Radiologic and endoscopic examinations revealed a large liver tumor occupying the right lobe, biliary dilation in the left lateral section, and a portal vein tumor thrombus. Invasion of the inferior vena cava and the right renal vein were also suspected. Intraoperative findings revealed a large liver tumor that occupied the right lobe and invaded the duodenum and jejunum. The tumor was resected successfully by right trisectionectomy, caudate lobectomy, pancreatoduodenectomy, partial resection of the jejunum, and combined portal vein resection and reconstruction. The inferior vena cava, right kidney, and renal vein could be detached from the tumor. The patient has enjoyed an active life without recurrence for 2 years since the operation.

Adult↗