Perforations of the rectosigmoid colon induced by cleansing enema: CT findings in 14 patients.

BACKGROUND: We report the computed tomographic (CT) features of colorectal perforations caused by cleansing enema. METHODS: We reviewed the medical records and CT studies of all patients with colorectal perforations caused by a cleansing enema. RESULTS: Fourteen patients (10 men, four women; average age = 80 years) were included in the study. The most common presenting symptoms were severe abdominal pain and fever. CT was performed within 48 h after the event in most patients. Extraluminal air in the perirectal fat was the most frequent finding on CT and was present in all patients. Additional findings were extraperitoneal ( n = 9), intraperitoneal ( n = 3) and /or subcutaneous ( n = 3) air, free fluid ( n = 9), extraluminal feces ( n = 8), and focal bowel wall thickening ( n = 4). No leak of contrast from the rectum was observed in any patient including the one patient in whom contrast was administered rectally. Ten patients were treated by surgery; five recovered and the other five died. The other four patients were treated conservatively and all four died. CONCLUSION: The diagnosis of colorectal perforation can be made on CT. Because the diagnosis is not always suspected by the clinician, the radiologist may be the first to suggest it. Therefore, the radiologist should be familiar with the CT features of a potentially lethal, rectally induced perforation.

Retroperitoneal perforation during endoscopic sphincterotomy: imaging findings.

BACKGROUND: Endoscopic retrograde cholangiopancreatography with sphincterotomy has become an important technique in the diagnosis and treatment of biliary and pancreatic diseases. Serious complications, although rare, may occur, and their early recognition and treatment are of the utmost importance. We encountered several such cases. This study reviews the imaging findings in patients with retroperitoneal perforation detected after the procedure. METHODS: Of 796 patients who had endoscopic sphincterotomy at our institution during a 9-year period, retroperitoneal perforation occurred in nine (1.13%). Imaging findings and clinical outcome were assessed. RESULTS: In eight patients, routine abdominal radiographs taken during the procedure disclosed retroperitoneal air, associated with extravasation of contrast material in six patients. This was further confirmed on computed tomography (CT) in three patients. In the ninth patient, the diagnosis was established by an emergent abdominal CT performed a day after the sphincterotomy, because of severe abdominal pain. Two patients died of overwhelming sepsis. CONCLUSIONS: Retroperitoneal perforation during endoscopic sphincterotomy is a rare complication, which occurred in 1.13% of our patients. It can be usually clearly recognized radiographically by an abdominal film and in doubtful cases by CT. We emphasize the importance of recognizing this potentially serious complication with imaging studies.

Intestinal malrotation as an incidental finding on CT in adults.

BACKGROUND: Intestinal malrotation in adults is usually an incidental finding on computed tomography (CT). We present the CT findings of 18 adult patients with malrotation and discuss the clinical implications. METHODS: Abdominal scans of 18 patients (12 women, six men; age range = 15-79 years) with intestinal malrotation were reviewed. Special attention was directed to the location of the superior mesenteric vessels, the location of the small and large bowels, the size of the uncinate process, the situs definition, and additional anomalies. RESULTS: The malrotation was an incidental finding in all but one patient. The malrotation was type Ia in 17 patients and IIc in the one symptomatic patient. The superior mesenteric vessels were vertically oriented in 10, inverted in two, normally positioned in four, and mirror imaged in two cases with situs ambiguus. All patients had aplasia of the pancreatic uncinate process, five had a short pancreas, and two had a preduodenal portal vein. Fourteen patients had a normal situs and four had heterotaxia. Seven patients had polysplenia, six of which with associated inferior vena cava anomalies. CONCLUSIONS: Intestinal malrotation can be diagnosed on CT by the anatomic location of a right-sided small bowel, left-sided colon, an abnormal relationship of the superior mesenteric vessels, and aplasia of the uncinate process. Awareness of these abnormalities is necessary to diagnose this anomaly. It should be sought in patients with a situs problem, inferior vena cava anomalies, polysplenia, or preduodenal portal vein. Although usually an incidental finding, it is important to diagnose such a malrotation because it may cause abdominal symptoms. Also, knowledge of associated vascular anomalies is important when abdominal surgery is planned.