Toxic Megacolon and Acute Ischemia of the Colon due to Sigmoid Stenosis Related to Diverticulitis.

We present a rare case of toxic megacolon accompanied by necrosis of the colon due to chronic dilation caused by stenosis of the sigmoid colon as a complication of diverticulitis. The patient presented at the emergency department with diffuse abdominal pain, fever (38.8°C) and tachycardia (120 beats/min). Physical examination revealed distension and tenderness on deep palpation on the left lower quadrant without peritoneal signs. Abdominal computed tomography showed located stenosis in the sigmoid colon and marked dilation of the descending (12 cm diameter) and transverse (7.5 cm diameter) colon. A few hours later, the patient developed severe septic shock with electrolyte abnormalities. He had a history of two prior admissions to our hospital due to crises of acute diverticulitis. Based on Jalan's criteria the diagnosis was compatible with toxic megacolon. The patient's condition deteriorated suddenly and an emergency colectomy was performed. The operative findings revealed a necrotic colon. Histology examination confirmed the diagnosis of ischemia of the colon. To our knowledge this is the first published report in the literature which refers to a rare complication of diverticulitis, namely chronic stenosis which complicated to colonic ischemia and toxic megacolon.

Familial renal retroperitoneal lymphangiomatosis: personal experience and review of literature.

Lymphangiomatosis of the kidneys and perirenal-retroperitoneal tissues is a rare disease of unknown etiology. We present two cases affecting members of the same family, supporting the familial nature of the disease. The natural history and related urological and systematic complications of the disease during a long-term follow-up are highlighted, while a comprehensive literature review is presented.

Hydatid hepatic cysts rupture into the biliary tract, the peritoneal cavity, the thoracic cavity and the hepatic subcapsular space: specific computed tomography findings.

BACKGROUND: This study attempts to demonstrate the role of computed tomography in the diagnosis of hepatic hydatid cyst rupture based on specific imaging findings and to propose combinations of the imaging findings diagnostic for specific types of rupture. METHODS: Eleven patients were studied with computed tomography of the abdomen, with 4-8 mm slice thickness, after the oral administration of contrast material and intravenous contrast material in 6 cases. RESULTS: Based on a combination of imaging findings the types of hepatic hydatid cyst rupture were: intrabiliary rupture in 7 patients, intraperitoneal rupture in 1 patient, intrathoracic rupture in 1 patient, hepatic subcapsular rupture in 2 patients. Structural deformity of the cyst was present in all cases, combined with: dilatation of the intrahepatic bile ducts (intrabiliary rupture); intraperitoneal fluid collections with diffuse haziness and stranding of the mesenteric fat (intraperitoneal rupture); an inhomogeneous lesion in the thorax with ipsilateral pleural effusion (intrathoracic rupture); a hydatid cyst located peripherally, with discontinuity of its adjacent to the hepatic capsule wall and subcapsular fluid collection (subcapsular rupture). The imaging findings were surgically and pathologically confirmed. CONCLUSIONS: Using combinations of specific imaging findings we correctly diagnosed the type of hepatic hydatid cyst rupture in all cases.

Complications of renal angiomyolipomas: CT evaluation.

Complications from angiomyolipomas are rare but often severe depending on the size and content of the angiomyolipoma. In this study, we describe 10 cases from 63 patients with renal angiomyolipomas in whom computed tomography revealed the following complications: compression of pyelocalyceal system in three cases, intratumoral bleeding in two cases, rupture in four cases with subcapsular, perirenal, or pararenal hematoma and extensive intrarenal/parapelvic hematoma, cystic degeneration in one case.

Synchronous bilateral multilocular renal cell carcinoma. A rare case.

A rare case of multilocular primary renal cell carcinoma (two sites in each kidney) in a 48-year-old woman is presented. The preoperative diagnosis was based on the computerized tomography findings. The patient underwent bilateral total nephrectomy and subsequently maintained renal dialysis.

Malignant schwannoma of the adrenals. A rare case.

This a rare case of malignant adrenal schwannoma in a woman aged 38 years old without family history of neurofibromatosis. A diagnosis is impossible before surgery.

Small lesions of the kidney: CT evaluation comparison with ultrasound.

Small lesions of the kidney: CT evaluation. Comparison with ultrasound. The main idea of this study is to demonstrate the usefulness, sensitivity and specificity of the CT method for the detection of small lesions of the kidneys. Simple cysts of kidneys were excluded from the study, which is a very frequent finding in patients examined with the new imaging methods of CT and US. Also the cases of small tumors which can add in establishment of diagnosis by CT are analysed. In this report 33 patients were examined with computed tomography (CT) and 36 small renal lesions (less than 4 cm) were found. Ten of these lesions were small angiomyolipomas (0.7-3.2 cm), 9 hemorrhagic renal cysts (0.8-3.5 cm), 5 adenomas of kidneys, 3 small Grawitz, 1 hydatid cyst, 1 lymphomatous deposit, 2 secondary tumors from the intestine, 2 oncocytomas, a small tumor 1.38 cm in size, who was not rendered a diagnosis, and 2 with false positive in ultrasound examination.