An unusual case of herniation of small bowel through an iatrogenic defect of the falciform ligament.

Internal herniation through a congenital defect in the falciform ligament is extremely rare. We report an unusual observation of small bowel obstruction through an iatrogenic defect of the falciform ligament. Prompt diagnosis was made by helical CT, permitting a rapid surgical procedure to preserve the viability of the obstructed segment.

[Multilocular cystic nephroma in adults. Unusual presentation and review of the literature]. / Néphrome kystique multiloculaire de l'adulte. Présentation inhabituelle et revue de littérature.

The authors report a case of a multilocular cystic nephroma in an unusual site, extensively invading the pelvis and causing atypical symptoms of acute lumbar pain. The authors discuss the confusing terminology, the unusual presentation of this cystic tumour and the difficulty of establishing a definitive diagnosis of its benign nature before the operation in the light of a brief review of the literature.

[Comparison of spiral computed tomography without contrast media and intravenous urography in the diagnosis of renal colic]. / Comparaison du scanner spiralé sans contraste et de l'urographie intraveineuse dans le diagnostic de la colique néphrétique.

OBJECTIVES: This prospective study was designed to determine the reliability of noncontrast spiral CT scan, compared to that of intravenous urography (IVU), in the diagnostic assessment of acute renal colic. MATERIAL AND METHODS: 53 patients, admitted with an empirical diagnosis of renal colic after initial assessment, were included and underwent spiral CT scan without contrast agent injection, immediately followed by IVU. These examinations were performed according to a blind protocol by two different radiologists. We initially looked for the presence of stones and/or urinary tract obstruction. Patients with a stone and/or obstruction (urinary tract dilatation) visible on CT scan were then examined for the presence of CT signs associated with stone disease (infiltration of the perirenal and periureteric fat, oedema of the ureteric wall and loss of sinus fat). We calculated the statistical correlation between the presence or absence of obstruction and these accessory signs. RESULTS: 45 stones were recovered (in 36 cases before the two examinations). 36 stones were identified on CT versus only 24 on urography. Urinary tract dilatation was demonstrated in 26 out of 53 cases by both urography and CT. The frequency of accessory signs visible on CT in the presence of stones (n = 36) was 66% for infiltration of periureteric fat, 36% for infiltration of perirenal fat and 75% for oedema of the ureteric wall. In the presence of urinary tract dilatation, these frequencies were 92%, 84% and 60% respectively. CONCLUSION: Noncontrast spiral CT is a reliable and rapid diagnostic modality for the detection of urinary stones, providing a morphological study equivalent to that of IVU and able to guide appropriate treatment. It should replace IVU in the diagnostic assessment of renal colic.

Radiologic investigation of renal colic: unenhanced helical CT compared with excretory urography.

OBJECTIVE: Our aim was to compare unenhanced helical CT and excretory urography in the assessment of patients with renal colic. SUBJECTS AND METHODS: Fifty-three of 70 consecutive patients with acute signs of renal colic were prospectively examined with unenhanced helical CT, which was followed immediately by excretory urography. Two radiologists who were unaware of the findings independently interpreted these examinations to determine the presence or absence of ureteral obstruction. On all CT scans that had positive findings for ureteral stones or obstruction, we looked for secondary signs of obstruction (perinephric or periureteral fat stranding, ureteral wall edema, ureteral dilatation, and blurring of renal sinus fat). RESULTS: A stone was recovered in 45 of the 53 patients, nine before and 36 after imaging. The latter 36 patients had their stones identified on CT, whereas only 24 patients had their stones identified on excretory urography. Eight patients without stone disease had normal ureters on both CT and excretory urography. Of the 45 patients who had stone disease, 26 had ureteral dilatation on both CT and excretory urography, and 36 patients who recovered a stone after CT had secondary signs of obstruction. Of the nine patients who recovered a stone before CT, three had secondary signs of obstruction. Two patients had periureteral fat stranding, ureteral wall edema, and renal sinus fat blurring. One patient had only ureteral wall edema. CONCLUSION: Compared with excretory urography, unenhanced helical CT is better for identifying ureteral stones in patients with acute ureterolithiasis. Secondary CT signs of obstruction, including renal sinus fat blurring, were frequently present even when the stone was eliminated before imaging.