[en] Paraduodenal hernias are the most common abdominal internal hernias. They present as recurrent episodes of poorly defined abdominal pain that either resolves or progresses toward a picture of intestinal obstruction. They can develop on the right or the left side. In the radiological diagnosis, intestinal transit shows the encapsulation of all or some of the loops of the small bowel, making it impossible to move them manually, and a certain degree of stasis in the herniated loops. It is important to be aware of the change in the situation of the mesenteric vessels. When a right Paraduodenal hernia is associated with an intestinal malformation, CT shows the rotation of the superior mesenteric vein, located on the left and ventrally to the superior mesenteric artery, as well as the absence of the horizontal portion of duodenum. (Author) 5 refs

No abstract available

[en] The purpose of this study was to compare a primary uncleansed 2D and a primary electronically cleansed 3D reading strategy in CTC in limited prepped patients. Seventy-two patients received a low-fibre diet with oral iodine before CT-colonography. Six novices and two experienced observers reviewed both cleansed and uncleansed examinations in randomized order. Mean per-polyp sensitivity was compared between the methods by using generalized estimating equations. Mean per-patient sensitivity, and specificity were compared using the McNemar test. Results were stratified for experience (experienced observers versus novice observers). Mean per-polyp sensitivity for polyps 6 mm or larger was significantly higher for novices using cleansed 3D (65%; 95%CI 57-73%) compared with uncleansed 2D (51%; 95%CI 44-59%). For experienced observers there was no significant difference. Mean per-patient sensitivity for polyps 6 mm or larger was significantly higher for novices as well: respectively 75% (95%CI 70-80%) versus 64% (95%CI 59-70%). For experienced observers there was no statistically significant difference. Specificity for both novices and experienced observers was not significantly different. For novices primary electronically cleansed 3D is better for polyp detection than primary uncleansed 2D. (orig.)

[en] We prospectively assessed the feasibility and acceptance of computerized tomographic colonography (CTC) without bowel cathartic preparation in elderly patients after incomplete colonoscopy. A total of 136 patients underwent CTC without cathartic preparation. The time delay between conventional colonoscopy and CTC ranged between 3 and 20 days, depending on the clinical situation. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. CTCs were interpreted using a primary two-dimensional (2D) approach and 3D images for further characterization. Patients were interviewed before and 2 weeks after CTC to assess preparation acceptance. CTC was feasible and technically successful in all the 136 patients. Fecal tagging was judged as excellent in 113 (83%) patients and sufficient in 23 (17%). Average CT image interpretation time was 14.8 min. Six (4.4%) cases of colorectal cancer and nine (6.6%) large polyps were detected, as well as 23 (11.3%) extracolonic findings of high clinical importance. No major side effect occurred, although 25% patients reported minor side effects, especially diarrhea. Overall, 76/98 patients replied that they would be willing to repeat the test if necessary. CTC without cathartic preparation is a technically feasible and safe procedure to complete a colonic study in the elderly, prompting its use in clinical practice. (orig.)

[en] Purpose: to compare highly accelerated parallel MRI of the bowel with conventional balanced FFE sequences in children with inflammatory bowel disease (IBD). Materials and methods: 20 children with suspected or proven IBD underwent MRI using a 1.5 T scanner after oral administration of 700-1000 ml of a Mannitol solution and an additional enema. The examination started with a 4-channel receiver coil and a conventional balanced FFE sequence in axial (2.5 s/slice) and coronal (4.7 s/slice) planes. Afterwards highly accelerated (R = 5) balanced FFE sequences in axial (0.5 s/slice) and coronal (0.9 s/slice) were performed using a 32-channel receiver coil and parallel imaging (SENSE). Both receiver coils achieved a resolution of 0.88 x 0.88 mm with a slice thickness of 5 mm (coronal) and 6 mm (axial) respectively. Using the conventional imaging technique, 4 - 8 breathholds were needed to cover the whole abdomen, while parallel imaging shortened the acquisition time down to a single breathhold. Two blinded radiologists did a consensus reading of the images regarding pathological findings, image quality, susceptibility to artifacts and bowel distension. The results for both coil systems were compared using the kappa-(κ)-coefficient, differences in the susceptibility to artifacts were checked with the Wilcoxon signed rank test. Statistical significance was assumed for p = 0.05. Results: 13 of the 20 children had inflammatory bowel wall changes at the time of the examination, which could be correctly diagnosed with both coil systems in 12 of 13 cases (92%). The comparison of both coil systems showed a good agreement for pathological findings (κ = 0.74 - 1.0) and the image quality. Using parallel imaging significantly more artifacts could be observed (κ = 0.47)

[en] The development of phytobezoars causing intestinal obstruction are reported in two patients who had undergone previous stomach surgery. The findings on plain radiography, ultrasonography and CT are described and the role of the latter as the method of choice in the diagnosis of this uncommon lesion is stressed. CT fulfills four objectives in this study: it confirms the presence of intestinal obstruction, determines the exact site and the cause, and detects the coexistence of gastric bezoar. The characteristic image of intestinal bezoar is that of an endoluminal mass containing a patchy gaseous area. (Author) 8 refs

[en] Multidetector computed tomography (MDCT) is the technique of choice for evaluating patients with acute abdominal pain. As the jejunum, ileum, and colon comprise the majority of the gastrointestinal tract, radiologists may potentially neglect the duodenum. However, the duodenum is a complex structure that can be affected by both intraperitoneal and extraperitoneal processes due to its central location and proximity to numerous upper abdominal structures. In this review, the MDCT findings of various congenital, inflammatory, traumatic, infectious, vascular, and miscellaneous conditions that affect the duodenum are discussed

[en] Objective: The purpose of this study was to assess the frequency of isolated small bowel dilatation on abdominal radiographs in patients with colonic fecal impaction and also to elucidate the cause of this finding. Methods: A computerized search of radiology files revealed 515 patients with colonic fecal impaction on abdominal radiographs. The radiologic reports described isolated small bowel dilatation not related to other known causes of ileus or obstruction in 18 (3.5%) of the 515 patients. The films were reviewed to determine the distribution of fecal impaction and the degree and extent of small bowel dilatation. In 16 cases, medical records were reviewed to determine the clinical presentation, treatment, and course. Finally, follow-up radiographs were reviewed in four cases to determine the response to treatment of the impaction. Results: All 16 patients with available medical records had abdominal symptoms. The average diameter of the dilated small bowel on abdominal radiographs was 3.7 cm. Fourteen patients (78%) had a diffuse colonic fecal impaction (nine) or a predominantly right-sided fecal impaction (five) that involved the cecum, and the remaining four (22%) had a left-sided colonic fecal impaction. All 12 patients with clinical follow-up had resolution of symptoms and all four with follow-up radiographs had resolution of small bowel dilatation after treatment of the underlying impaction. Conclusion: Fecal impaction should be considered in the differential diagnosis of small bowel dilatation on abdominal radiographs, as treatment of the underlying impaction usually produces a dramatic clinical response with resolution of the small bowel dilatation on follow-up radiographs

[en] One hundred and eighty on cases, which confirmed to be intussusception, were reviewed retrospectively to identify the differences between radiologic findings of reduced and nonreduced intussuceptions by barium enema. The number of cases of reduced intussusception was 148 and nonreduced was 33, so the rate of reduction was 82%. On conventional radiographs, air-fluid levels were seen in 23 cases(15.5%) of the reduced intussusception and in 18 cases(54.6%) of the nonreduced intussusception, and soft tissue masses were seen in 20 cases(13.5%) of the reduced intussusception and in 12 cases(36.4%) of the nonreduced intussusception. The mean value of a ratio of maximal diameter of small bowel to interpedicular distance of L3 vertebral body was 0.93 in the reduced intussusception and 1.25 in the nonreduced intussusception. On barium enema, the dissection sign wa seen in 33.1% of the reduced intussusception and in 75.8% of the nonreduced intususception. The morphologic abnormalities of ascending colon were seen in 11.5% of the reduced intussusception and in 38.7% of the nonreduced intussusception. So, the findings of air-fluid level, soft tissue mass, marked small bowel dilatation, dissection sign and morphologic abnormality of ascending colon were more frequently seen in the nonreduced intussusception than the reduced cases. There was no correlation between the location of intussusceptum and the reduction rate

[en] Acute intestinal inflammation is common. In most cases the medical history, clinical investigations and laboratory parameters alone are not sufficient for a conclusive diagnosis because of the wide variety of differential diagnoses and the striking similarity of symptoms. Modern imaging methods can help to clarify the diagnosis and multi-slice CT (MSCT) is highly useful in this diagnostic dilemma. It is widely available, employs standardized protocols, is cost-effective and can be performed within an acceptable examination time. MSCT enables the location and extension of the underlying pathology to be assessed and detection of complications which require immediate therapeutic intervention. (orig.)