RESUMEN
We report the radiographic findings of ischemic hepatitis in a patient with cirrhosis. The abdominal ultrasound exam showed multiple hypoechoic nodules in the liver measuring up to 2 cm, suggestive of diffuse metastatic disease. Abdominal computed tomography (CT) scan revealed multiple hypodense masses throughout the liver with no enhancement. Liver biopsy revealed coagulative hepatocyte necrosis at the center of the regenerative nodules. Repeat CT scan obtained 5 months later showed complete resolution of the hypodense nodules. Ischemic necrosis of regenerative nodules should be differentiated from diffuse hepatic metastatic disease in the setting of ischemic hepatitis in cirrhotic patients.
Asunto(s)
Hepatitis/diagnóstico por imagen , Isquemia/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Hígado/irrigación sanguínea , Adulto , Biopsia , Diagnóstico Diferencial , Hepatitis/patología , Hepatocitos/patología , Humanos , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Regeneración Hepática , Masculino , Necrosis , Radiografía Abdominal , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
OBJECTIVE: Because of the increased risk of colorectal cancer in patients with long-standing ulcerative colitis, colonoscopic surveillance for the detection of dysplasia is currently recommended as a method of identifying high-risk patients. However, the hazard of colonoscopy with multiple biopsies in such patients is not well known. Our objective was to assess the safety of surveillance colonoscopy in patients with long-standing ulcerative colitis. METHODS: To accomplish our objective, we conducted a retrospective analysis of results and follow-up of surveillance colonoscopies. RESULTS: A total of 6,727 biopsies were obtained during 384 colonoscopies, with a median of 17 biopsies per colonoscopy. Nineteen studies were performed in a setting of underlying stricture. A single complication of a silent perforation occurred in a patient with an underlying stricture. No instances of bleeding, infection, respiratory distress, myocardial infarction, or death resulted from the procedure. CONCLUSION: Our findings suggest that surveillance colonoscopy with multiple biopsies is a relatively safe procedure. Given increasing evidence of the survival benefit derived from the procedure, we believe these results render further support for the current practice of surveillance colonoscopy in patients with ulcerative colitis.