[Colostomy vs self-expanding metallic stents: comparison of the two techniques in acute tumoral left colonic obstruction]. / Colostomie de décharge vs endoprothèse colique autoexpansive: comparaison des deux techniques dans l'occlusion colique gauche aiguë par obstacle tumoral.

UNLABELLED: Self-expanding metallic stents is an alternative treatment to colostomy that is the treatment of choice in acute tumoral left colonic obstruction. AIM OF THE STUDY: To compare morbidity, mortality, length of hospital stay and treatment performed after desobstruction using the two methods. PATIENTS AND METHODS: Thirty-three patients admitted for acute obstruction of the left colon were retrospectively separated in two groups depending on the type of intervention performed to treat the obstruction ("colostomy" group: 17 patients and "self-expanding stent group": 16 patients). We studied complications after desobstruction, hospital courses and surgical strategy performed after the acute phase. RESULTS: Time between desobstruction and colectomy was shorter in the "self-expanding stent group" than in the "colostomy group" (18.5 days versus 73 days). Age superior than 75 years and colostomy were the two main factors predicting the risk of definitive colostomy (P < 0.05). Global mean hospital stay was longer in the colostomy group (32.7 days versus 19.3 days, P = 0.02). Two perforations and one local recurrence occurred in the "self-expanding stent group". CONCLUSIONS: Self-expanding metallic stent can decrease the permanent colostomy rate and the number of interventions. The recurrence rate seems to be theoretically increased with the stenting method. Then, colostomy must be done for patients in curative situation. The self-expanding metallic stent should be used as a palliative care.

[MRI of an afferent loop syndrome presenting as obstructive icterus]. / IRM d'un syndrome de l'anse afférente révélé par un ictère obstructif.

The afferent loop syndrome corresponds to an acute or chronic obstruction of the afferent loop following a partial gastrectomy with Billroth II gastro-jejunal anastomosis. We describe the case of a 77-year-old man with history of partial gastrectomy for peptic ulcer disease performed 31 years ago and currently admitted for jaundice and poor general status. MR imaging showed dilatation of biliary and pancreatic ducts and showed a soft tissue mass between the afferent loop and the residual stomach. Endoscopy showed complete obstruction of the afferent loop by a biopsy-proven adenocarcinoma. The patient died of sepsis shortly after endoscopy of septicemia.

Ascending colonic variceal bleeding: utility of phase-contrast MR portography in diagnosis and follow-up after treatment with TIPS and variceal embolization.

The authors describe the discovery of ascending colonic variceal veins via celiomesenteric diagnostic angiography following a bout of melena in a 44-year-old woman. Magnetic resonance imaging, including phase-contrast MR venography, allowed visualization of the portal and systemic veins immediately after the initial angiograms. The hemorrhagic episode did not resolve until after transjugular intrahepatic shunt insertion and selective variceal embolization through the shunt. At 1 week-, 3 months-, and 6 months post treatment, follow-up MR venography no longer revealed the presence of colonic varices. Colonoscopy at 6 months was normal and the patient did not have any further episodes of bleeding until a liver transplantation was performed after 9 months.

[Macroscopic intrahepatic portosystemic venous shunt: review of the literature and reclassification]. / Shunts veineux portosystemiques intrahepatiques macroscopiques: revue de la litterature et reclassification.

Macroscopic intrahepatic portosystemic venous shunts (IHPSS) are defined as communications between the portal and the systemic venous circulation, measuring more than 1mm in diameter, and at least partially located inside the liver. Four different types can be identified based on anatomical, clinical, and pathophysiological criteria. Type I includes patent paraumbilical veins, located in the liver, and commonly encountered in portal hypertension. Types II, III, and IV are much less common and have been reported in only 47 publications in the entire French and English literature. They include shunts, unique or multiple, between a portal branch and a hepatic vein, located either in two adjacent liver segments (type II) or in non-adjacent liver segments (type III). Type IV corresponds to any tubular communication developed between the right portal branch and the inferior vena cava. The exceptional patent ductus venosus or a patent umbilical vein should not be considered as IHPSS since their course is strictly extrahepatic.

Agenesis of the horizontal segment of the left portal vein demonstrated by magnetic resonance imaging including phase-contrast magnetic resonance venography.

Two cases of agenesis of the horizontal segment of the left portal vein are reported. This very rare vascular anomaly probably corresponds to an embryological variation rather than to an obstruction of the left portal vein. In almost all cases liver ultrasonography is sufficient for identifying such vascular abnormalities. It shows a large aberrant vessel emerging from a right anterior segmental portal branch and running transversely in the quadrate lobe towards the teres ligamentum from which the portal supply to the left lobe arises. It is important to be able to recognize the magnetic resonance imaging features of this vascular variation, as magnetic resonance imaging may be the initial imaging study, and ultrasound may be technically challenging. To our knowledge, we present the first description of these features, including an enhanced gradient-echo T1-weighted sequence, a turbo spin-echo T2-weighted sequence with fat saturation, and a three-dimensional phase-contrast magnetic resonance portography.

[Radiologic aspects of the complications of duodenal diverticula]. / Aspects radiologiques des complications des diverticules duodénaux.

The duodenum is the second most common site, after the colon, for intestinal diverticulae. This condition is most often asymptomatic and is usually an accidental finding. Complications, with variable clinical presentations, may occur in up to 5% of such individuals. We report a retrospective analysis of 5 patients who presented with complicated duodenal diverticular disease. The complications, either isolated or multiple, consisted of bezoar formation (n = 2), diverticulitis (n = 2), extrinsic compression of the common bile duct (n = 3), perforation (n = 1), choledocholithiasis (n = 1), and an abnormality of the bilio-pancreatic ductal convergence (n = 1). The radiological aspects, in particular, the magnetic resonance imaging (MRI) features are reviewed. These are, to our knowledge, the first descriptions of MRI and magnetic resonance cholangiopancreatographic (MRCP) findings in complicated duodenal diverticular disease. MRI facilitates precise delineation of the complicated duodenal diverticulum while MRCP allows assessment of the effects on the biliary and pancreatic ducts.

[Ultrasonographic and MRI aspects of cystic duodenal dystrophy with aberrant pancreatic tissue]. / Aspects en echographie et en IRM d'une dystrophie kystique duodenale sur pancreas aberrant.

US and MR features (including MR cholangiopancreatography) of a cystic formation in a duodenal heterotopic pancreas are reported. To our knowledge, MR cholangiopancreatography of this uncommon condition has not been previously described. Imaging showed multiple cysts within a thickened duodenal wall. This thickness of the duodenal wall was related to a heterotopic pancreas with chronic pancreatitis.

[Fibrous splenic hamartoma: imaging features]. / Imagerie d'un hamartome splénique de type fibreux.

Splenoma or splenic hamartoma is a rare primary splenic tumor most often incidentally discovered. The authors report the case of a splenic hamartoma, developed in an asymptomatic man and imaged by US, CT and MRI. This tumor which measured 7 cm in diameter, was hypoechoic with posterior hardening of the ultrasound beam, and not much vascularized as demonstrated by Duplex and color Doppler examination. The tumor MR imaging showed hyperintensity on T1-weighted and hypointensity on T2-weighted. The final diagnosis was not established until the histologic examination of the splenectomy specimen was performed. Histopathologically, the tumor corresponded to a fibrous type of splenic hamartoma. The atypical imaging features which led to splenectomy were probably related to the fibrous component of the hamartoma.

[Fracture of the sacrum caused by bone insufficiency in a pregnant woman]. / Fracture du sacrum par insuffisance osseuse chez une femme enceinte.

Sacral insufficiency fractures are not rare. They are well known in female patients over age 50 with osteopenia. One case occurring in a young pregnant woman is described. We did not find another case in the literature.