RESUMEN
This paper presents the case of a 32-year-old female patient with acute colon incarceration in the thoracic cavity due to Bochdalek hernia. An asymptomatic right Bochdalek hernia was also discovered, which is a rare finding. The patient underwent laparotomy with reposition of the incarcerated organs and primary closure of the left-sided defect. The stenotic portion of the originally incarcerated colon was resected one year later due to the symptoms of chronic bowel problems. At present, 18 months from the first surgery, the patient's clinical condition remains good with a positive clinical response to the secondary surgery involving resection of the stenotic colon, and the right Bochdalek hernia remains asymptomatic.
Asunto(s)
Enfermedades del Colon , Adulto , Femenino , Humanos , Enfermedades del Colon/cirugía , Enfermedades del Colon/diagnóstico por imagen , Hernia Diafragmática/cirugía , Hernia Diafragmática/diagnóstico por imagen , Hernias Diafragmáticas Congénitas/cirugía , Hernias Diafragmáticas Congénitas/diagnóstico por imagen , Hernias Diafragmáticas Congénitas/complicaciones , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico por imagenRESUMEN
BACKGROUND: Iatrogenic colon perforation (ICP) due to colonoscopy is a severe complication and is associated with significant morbidity and mortality. The global estimated incidence of ICP is 0.03% and up to 3% for diagnostic and therapeutic colonoscopies, respectively. Treatment options include endoscopic repair, conservative therapy, and surgery. Treatment decision is based on the time and the setting of the diagnosis, the type, and location of the perforation, the presence of related pathologies, the clinical status and characteristic of the patient, and surgeon's skills. We present our experience in the treatment of ICPs. METHODS: A retrospective review was undertaken of all patients suffering from ICP at Bnai-Zion Medical Center between 1/1/2010 and 1/3/2021. Clinical presentation, therapeutic approach, and short-term outcomes were analyzed. RESULTS: There were 51 cases of ICPs. Fourteen (27%) were diagnosed by the gastroenterologist during the procedure, 2 of whom were treated with endoscopic clips. The rest of the patients (72.5%) were diagnosed in the ER after a CT scan. Forty-three patients (84%) went on to operative management: 5 (11%) operations started with laparotomy-all were conducted in the early study period (until 2013). All other operations (88%) started with a diagnostic laparoscopy, 4 of whom (10%) were converted to laparotomy. Out of the 38 laparoscopic cases 29 (80%) were treated with primary suturing. Seven patients went on to colon resection (5 of whom with primary anastomosis). Six patients required ICU admission-with 1/38 (2%) from the laparoscopic cases, and 5/9 (55%) from the laparotomy cases. A total of 49/51 (96%) patients recovered and were discharged after 5 ± 2 for conservative and laparoscopic cases, and 12 ± 9 for open cases. CONCLUSION: Laparoscopic treatment of ICP is safe and feasible in most cases. Our data supports a laparoscopic attempt at any such scenario.
Asunto(s)
Enfermedades del Colon , Perforación Intestinal , Laparoscopía , Humanos , Enfermedad Iatrogénica , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Colonoscopía/efectos adversos , Colonoscopía/métodos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Estudios Retrospectivos , Colon/cirugía , Resultado del TratamientoRESUMEN
We present a case of a 17-year-old woman with ulcerative colitis (UC) presented with abdominal pain and hematochezia. A CT scan showed active bowel inflammation, presenting the Chinese dragon sign. A diagnosis of exacerbation of UC was made. This sign refers to tortuous thick-walled sigmoid colon and rectum with narrow lumen resembles the body of the dragon and hypervascularity of the involved mesenteric vessels as bright dots next to the outer wall resemble the legs and skin spikes. Although this sign is nonspecific and may appear in ischemic colitis, ischemic colitis usually does not have rectal involvement and can be differentiated from typical UC.
Asunto(s)
Colitis Ulcerosa , Adolescente , Femenino , Humanos , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/diagnóstico por imagen , Colon Sigmoide/diagnóstico por imagen , Enfermedades del Colon/diagnóstico por imagen , Recto/diagnóstico por imagenRESUMEN
BACKGROUND: Curvilinear array ultrasound transducers enable tissue sampling and have therapeutic capabilities. Nevertheless, colonic intubation and maneuvering with these transducers is technically challenging and is therefore typically limited to the rectosigmoid area. This retrospective cohort study aimed to evaluate the safety, feasibility, and diagnostic yield of colonoscopic ultrasound-guided fine-needle aspiration in deep colonic intubation. IMPACT OF INNOVATION: The impact of this innovation is to enable tissue sampling of colonic and extracolonic lesions guided by endoscopic ultrasound. TECHNOLOGY, MATERIALS, AND METHODS: Curvilinear array ultrasound is used in the evaluation of luminal and extraluminal colonic diseases. Thirteen patients underwent colonoscopic ultrasound with a curvilinear array ultrasound endoscope in a single center for subepithelial lesions, cancer staging, and extracolonic lesions from July 2015 to February 2021. Endosonography was performed using an Olympus EU-ME1 and GF-UCT 180 with a 5-12MHz curvilinear array transducer. The primary outcome was the percentage of patients who were successfully scanned with the endoscopic ultrasound. The secondary outcomes included the success rate of fine-needle aspiration, the diagnostic yield of the tissue samples, and the adverse events related to the procedure. PRELIMINARY RESULTS: A total of 13 female patients underwent colonoscopic ultrasound. All patients (100%, 13/13) were successfully scanned. Fine-needle aspiration was deemed necessary and successfully performed in 100% (5/5) of the patients. Tissue samples collected by fine-needle aspiration resulted in a diagnostic yield of 60%, and no adverse events resulted from this intervention. CONCLUSIONS: This study demonstrates the feasibility of performing colonoscopic ultrasound with a curvilinear array transducer. Fine-needle aspiration for subepithelial, colonic, and extracolonic lesions is feasible and safe in this setting with no adverse events reported in our study. FUTURE DIRECTIONS: Future research should be directed toward validating colonoscopic ultrasound with a curvilinear array transducer technique in prospective randomized trials. Studies evaluating the feasibility and safety of endoscopic ultrasound-guided interventions in the colon, such as abscess drainage and enteral anastomosis, should be considered.
Asunto(s)
Enfermedades del Colon/patología , Colonoscopía/instrumentación , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/instrumentación , Endosonografía/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Colon/diagnóstico por imagen , Colonoscopía/efectos adversos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Endosonografía/efectos adversos , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We report a case of a 77-year-old man presented with abdominal pain, melena and weight loss.He underwent endoscopic evaluation revealed a 1.2cmX0.6cm ulcer of the greater curve of the antrum stomach and a 1.3cm fistulous tract .The gastroscope can smoothly enter the transverse colon through the fistula tract, and we can be able to visualize the colon wall and feces.After the diagnosis of gastrocolic fistula based on endoscopic findings. The patient was referred for surgical evaluation and underwent laparotomy. The patient subsequently underwent en-bloc resection of the fistula, a segment of the transverse colon, gastric perforation repair, intestinal adhesion lysis and peritoneal drainage. Examination of the specimen revealed a fistulous communication between the stomach and resected transverse colon segment. Finally, the patient was discharged 10 days after operation and without further complication.
Asunto(s)
Colon Transverso , Enfermedades del Colon , Fístula Gástrica , Fístula Intestinal , Úlcera Gástrica , Anciano , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Masculino , Úlcera Gástrica/complicaciones , Úlcera Gástrica/diagnóstico por imagen , Úlcera Gástrica/cirugíaRESUMEN
PURPOSE: To evaluate extracellular matrix enterocutaneous fistula plugs (ECMFPs) in treatment of enteric fistulae at a single institution. MATERIALS AND METHODS: The study included 18 patients who had an ECMFP placed between 2012 and 2018 with treatment follow-up through July 2020. Median patient age was 52.5 years (interquartile range, 11.5 y). There were 28 ECMFP procedures performed on 19 separate fistulae. Fistulae locations were gastrocutaneous (n = 4), enterocutaneous (n = 9), and colocutaneous (n = 6). Descriptive statistics were used to define closure rates, recurrence rates, and complications. RESULTS: Fistula closure was achieved in 1 of 4 gastrocutaneous (25%), 4 of 9 enterocutaneous (44%), and 3 of 6 colocutaneous (50%) locations. The median time from procedure to fistula tract closure was 29 days interquartile range 25 days. The median time from ECMFP placement to fistula recurrence was 28 days (interquartile range 27 days). Of the fistulae that eventually closed, 6 of 8 closed after the first attempt (75%), and 2 closed after the second attempt (25%). Of the procedures that resulted in complete closure, 7 of 8 were categorized as low flow, and 1 of 8 was categorized as high flow. Complications were seen in 4 patients (23%), with major complications in 3 patients (17%). CONCLUSIONS: Low-flow fistulae originating from the small bowel are most likely to have complete closure. High-flow and/or gastrocutaneous fistulae are less likely to benefit from this intervention. In patients who are not surgical candidates or who have failed surgical management, ECMFPs may provide a solution.
Asunto(s)
Enfermedades del Colon/cirugía , Fístula Cutánea/cirugía , Matriz Extracelular/trasplante , Fístula Gástrica/cirugía , Fístula Intestinal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Colon/diagnóstico por imagen , Fístula Cutánea/diagnóstico por imagen , Femenino , Fístula Gástrica/diagnóstico por imagen , Humanos , Fístula Intestinal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
A 63-year-old male presented to the Emergency Department with weakness and hematochezia. He was found to have a massive gastroepiploic artery pseudoaneurysm that had eroded into the transverse colon. He underwent open en bloc resection of the aneurysm, a portion of the stomach, and a portion of the transverse colon. The case and a brief review of gastroepiploic aneurysms is presented.
Asunto(s)
Aneurisma Falso/complicaciones , Enfermedades del Colon/etiología , Arteria Gastroepiploica , Fístula Intestinal/etiología , Fístula Vascular/etiología , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/cirugía , Arteria Gastroepiploica/diagnóstico por imagen , Arteria Gastroepiploica/cirugía , Hemorragia Gastrointestinal/etiología , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugíaRESUMEN
BACKGROUND: Ileocolonoscopy with histology has been considered the gold standard for Crohn disease (CD) diagnosis and monitoring. Over the last years, magnetic resonance enterography (MRE) has become more and more popular, representing a valid non-invasive technique. OBJECTIVE: To propose a simplified MRE score, the pediatric CD magnetic resonance index (PCDMRI), based only on the most affected bowel segment, to grade active inflammation in children with CD. MATERIALS AND METHODS: Two radiologists retrospectively evaluated MRE images of children with histopathology-proven CD. The PCDMRI was based on six mural and perimural variables assessed for the most affected bowel segment (chosen by visual inspection of the key bowel wall imaging findings associated with active inflammation), and five extramural per-examination features. Correlation analysis was performed between both the PCDMRI and the MRE global score (based on all the affected segments) and the pediatric clinical disease activity index (PCDAI), the simple endoscopic score for CD (SES-CD), serum C-reactive protein (CRP) and fecal calprotectin (fC). Inter-reader reproducibility of the scoring system was estimated. Agreement on disease location between MRE and ileocolonoscopy was evaluated. RESULTS: The study involved 42 children for a total of 80 MRE. PCDMRI and global score positively correlated with PCDAI, SES-CD, CRP and fC. Inter-reader reproducibility was 91%. Agreement on disease location was substantial. CONCLUSION: The PCDMRI and the global score resulted equally correlated with the PCDAI, suggesting a high impact of the most affected segment on symptoms. The PDCMRI may be a useful non-invasive tool for a rapid and reproducible grading of the disease activity in children with ileocolonic CD.
Asunto(s)
Enfermedades del Colon/diagnóstico por imagen , Enfermedad de Crohn/diagnóstico por imagen , Enfermedades del Íleon/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adolescente , Niño , Preescolar , Enfermedades del Colon/complicaciones , Enfermedad de Crohn/complicaciones , Femenino , Humanos , Enfermedades del Íleon/complicaciones , Masculino , Estudios RetrospectivosRESUMEN
Reports of intussusception in sea turtles are generally linked to marine debris ingestion; therefore, only a few cases of the disease are associated with parasitic infestations. The objective of this study was to describe the necropsy findings of the first reported case of colocolic intussusception in a green sea turtle Chelonia mydas, associated with the helminth Octangium sp. A juvenile female green sea turtle, which was registered and rescued by the team from the Cetaceans Project of Costa Branca, State University of Rio Grande do Norte, was examined. The animal died 1 d after being treated and was immediately submitted for necropsy. Our findings indicated that parasitic infestation by Octangium sp. in the green sea turtle caused intussusception and consequently led to the animal's death. Early diagnosis and surgical correction are fundamental for a good prognosis and, consequently, for successful rehabilitation of marine species.
Asunto(s)
Enfermedades del Colon/veterinaria , Intususcepción/veterinaria , Trematodos/aislamiento & purificación , Infecciones por Trematodos/veterinaria , Tortugas , Animales , Brasil , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/parasitología , Enfermedades Funcionales del Colon , Femenino , Enfermedades del Sigmoide , Infecciones por Trematodos/diagnóstico , Infecciones por Trematodos/diagnóstico por imagen , Infecciones por Trematodos/parasitologíaRESUMEN
An earlier incorrect version of this article appeared online. This article was corrected on December 20, 2019.
Asunto(s)
Enfermedades del Colon/diagnóstico por imagen , Colonografía Tomográfica Computarizada , Artefactos , Diagnóstico Diferencial , Errores Diagnósticos/prevención & control , Humanos , Imagenología TridimensionalRESUMEN
Adult intussusception is an uncommon cause of abdominal pain and poses diagnostic challenges for emergency physicians due to its varied presenting symptoms and time course. We report a case of chronic colocolic intussusception secondary to a lead point submucosal lipoma. Dedifferentiating intussusception with or without a lead point is important in determining appropriate management.
Asunto(s)
Enfermedades del Colon/etiología , Neoplasias del Colon/complicaciones , Intususcepción/etiología , Lipoma/complicaciones , Dolor Abdominal/etiología , Adulto , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/diagnóstico por imagen , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/diagnóstico por imagen , Humanos , Intususcepción/diagnóstico , Intususcepción/diagnóstico por imagen , Lipoma/diagnóstico , Lipoma/diagnóstico por imagen , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Spontaneous intramural hematoma of the alimentary canal has rarely been reported. We present two cases in which anticoagulation therapy brings spontaneous intramural hematoma of the alimentary canal. In one case, the lesion was located in the ileum, and the other was located in the ascending colon and distal ileum. Both patients were cured through conservative treatment. We suggest that increased attention should be paid if a patient has acute abdominal pain with a history of oral anticoagulant therapy, and the diagnosis of spontaneous intermural hematoma should be considered.
Asunto(s)
Enfermedades del Colon/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico , Hematoma/diagnóstico , Enfermedades del Íleon/diagnóstico , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Enfermedades del Colon/inducido químicamente , Femenino , Hemorragia Gastrointestinal/inducido químicamente , Hemorragia Gastrointestinal/diagnóstico por imagen , Hematoma/inducido químicamente , Hematoma/diagnóstico por imagen , Humanos , Enfermedades del Íleon/inducido químicamente , Enfermedades del Íleon/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
BACKGROUND: Various patterns of colonic mucosal irregularity have been recorded on contrast enema, each with individually very low sensitivity, but high specificity. OBJECTIVE: To assess the accuracy of the radiologic features of Hirschsprung disease utilising a unifying stratification of any form of colonic mucosal irregularity on contrast enema. MATERIALS AND METHODS: We conducted a retrospective study of children with suspected Hirschsprung disease managed at a tertiary South African hospital from January 2009 through April 2015. Three observers independently reviewed abdominal radiographs and contrast enemas. The enema analysis included a unifying category of any form of colonic mucosal irregularity. Radiologic features were compared with rectal biopsy results. We used descriptive statistics and the Fisher exact test to compare the radiologic features of children with and without Hirschsprung disease. RESULTS: Ninety-two children with median age of 37 days (range 3 days to 11 years) were included; 50 had biopsy-proven Hirschsprung disease. On enema, any mucosal irregularity, a transition zone and recto-sigmoid ratio inversion were associated with Hirschsprung disease (all P<0.01). Mucosal irregularity showed 96% sensitivity (95% confidence interval [CI] 86.3-99.5) and 71.4% specificity (CI 55.4-84.3); a transition zone showed 86% sensitivity (CI 73.3-94.2) and 90.5% specificity (CI 77.4-97.3); and recto-sigmoid ratio inversion showed 78% sensitivity (CI 64.0-88.5) and 83.3% specificity (CI 68.3-93.0). CONCLUSION: Colonic mucosal irregularity on contrast enema has high sensitivity and moderate specificity for Hirschsprung disease.
Asunto(s)
Enfermedades del Colon/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Enema , Enfermedad de Hirschsprung/diagnóstico por imagen , Biopsia , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Sensibilidad y Especificidad , SudáfricaRESUMEN
There are multiple indications for luminal imaging of the colon. From assessment of known disease, to diagnosing new pathology; intra-luminal visualisation is the mainstay of gastrointestinal diagnosis. Colonoscopy and radiological imaging are currently the most frequently deployed diagnostic methods. However, both have an associated risk profile, have significant resource pressures and are not universally tolerated. Colon capsule endoscopy (CCE) offers an adjunct to these diagnostic options. In this narrative review the utility of CCE is described. Its current uses, potential benefits and future developments are also discussed.
Asunto(s)
Endoscopía Capsular , Enfermedades del Colon/diagnóstico por imagen , Colonoscopía/métodos , Endoscopía Capsular/instrumentación , Colonoscopía/instrumentación , HumanosRESUMEN
Colocolic intussusception is a variation of intussusception that is rarely encountered in pediatric patients and as such can prove to be a diagnostic challenge for both the emergency clinician and radiologist. Knowledge of the presentation and imaging findings in these cases can expedite diagnosis and guide the patient to appropriate treatment. The demographics, clinical symptoms, imaging findings, and eventual surgical and pathologic outcomes of 8 children with colocolic intussusception will be presented in this pictorial essay, with a review of the available literature.
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Enfermedades del Colon/diagnóstico por imagen , Intususcepción/diagnóstico por imagen , Adolescente , Niño , Preescolar , Enfermedades del Colon/terapia , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Intususcepción/terapia , MasculinoRESUMEN
This is the 45th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC.
Asunto(s)
Enfermedades del Colon/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anomalía Torsional/diagnóstico por imagen , Dolor Abdominal/diagnóstico por imagen , Dolor Abdominal/etiología , Enfermedades del Colon/complicaciones , Medios de Contraste , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Femenino , Humanos , Persona de Mediana Edad , Anomalía Torsional/complicacionesRESUMEN
Colonic torsion is a life-threatening condition that results in colonic ischemia, necrosis, perforation, sepsis, and eventual death. The aim of this multicenter, retrospective case series study was to describe the CT findings in dogs with surgically confirmed colonic torsion. Medical records were searched for dogs with surgically confirmed colonic torsion following abdominal CT. Five dogs met the inclusion criteria. Three had a history of chronic intermittent diarrhea prior to presentation. Two dogs presented with acute vomiting, diarrhea, and abdominal pain and one dog presented with acute vomiting and lethargy. Computed tomographic findings in all dogs with surgically confirmed colonic torsion include: "whirl sign," displacement and distension of the cecum and colon, focal narrowing of the colon, and distension of the mesenteric vasculature in all dogs (5/5); streaky peritoneal fat and peritoneal effusion (4/5), pneumatosis coli (2/5), small intestinal distension (2/5), portal vein thrombosis (1/5), and reduced colonic wall contrast enhancement (1/5). In all dogs (5/5), the torsion site was the descending colon and demonstrated an anticlockwise rotation. At surgery, three of the five dogs had a partial colonic torsion with hyperemia at the site of obstruction and two of the five dogs had a complete torsion with marked necrosis of the colonic wall. Displacement of the colon and cecum, segmental distension and focal narrowing of the colon, the presence of a "whirl sign" and distension of the mesenteric vasculature are CT findings highly suggestive of colonic torsion.