abdominal emergencies radiology

Although relatively benign, in advanced cases, pneumatosis and portomesenteric venous gas can signal the presence of infarction. Possible causes of benign esophageal strictures include long-standing gastroesophageal reflux, radiation, chronic medication-induced esophagitis, nasogastric intubation, epidermolysis bullosa, and eosinophilic esophagitis. On plain radiography, dilated colon (dilation being a caliber greater than 6 cm and 9 cm in the cecum) is seen. In chronic UC the colon becomes foreshortened, and featureless, with the loss of haustral folds, and exhibits luminal narrowing. Other motility disorders, such as scleroderma and administration of anticholinergic or opioid medications, also may lead to the performance of CT, in patients presenting with acute abdominal pain. If the hemorrhage is acute, the hematoma may have high density. Sigmoid volvulus may be treated nonoperatively with proctoscopic/colonoscopic decompression with a high success rate. 13-27 ). Online case-based review of abdominal emergency radiology featuring over 6 hours of video recordings by Dr Vikas Shah, Dr Jeremy Jones and Dr Andrew Dixon. The nitrous oxide created from the inflammation is believed to inhibit smooth muscle tone, resulting in bowel distention. The fistulous tract may also extend circumferentially in the ischiorectal fossa with the tract passing into the contralateral fossa through the posterior rectum, forming a horseshoe fistula. Maximum intensity projection images and other postprocessing techniques, such as volume-rendering techniques, can improve depiction of the vasculature and bowel anatomy and improve the communication of findings ( Fig. This relative transition often occurs at the splenic flexure where the parasympathetic bowel innervation changes from the vagal nerve to the sacral nerve, lending support to the hypothesis that transient impairment of the sacral plexus leads to functional obstruction of the proximal colon. Nonetheless, lymph nodes larger than 10 mm in short axis should prompt evaluation for superimposed lymphoma or carcinoma ( Figs. Crohn disease is part of the IBD spectrum, characterized by chronic, relapsing inflammation of unknown cause. 40 year old woman with two days of abdominal pain. Colonic intussusception refers to invagination or telescoping of a proximal loop of bowel (intussusceptum) into the lumen of an adjacent, distal segment of bowel (intussuscipiens). The epithelium regenerates between acute inflammatory attacks, resulting in the formation of pseudopolyps, usually seen in long-standing disease. On CT a distended colon with a markedly thickened and nodular bowel wall and submucosal edema may be seen ( Fig. 13-3 ). In the absence of appropriate treatment, there may be progressive colonic inflammation with transmural necrosis, perforation, and even death. This type of gastric volvulus is more commonly associated with diaphragmatic defects and vascular compromise. Patients typically present with abdominal pain, nausea, and vomiting, and in patients with an underlying malignancy, weight loss, palpable abdominal mass, melena, and constipation may be seen. Acute appendicitis is the most common acute abdominal emergency requiring surgery and typically presents as periumbilical pain that migrates to the right lower quadrant with other characteristic clinical signs and symptoms, including nausea, anorexia, and fever, although the clinical presentation is highly variable. Similar to esophageal dissection, full-thickness esophageal perforation may be iatrogenic, such as from surgery, stricture dilatation, stenting, or thermal injury. Patients with typhlitis typically present with abdominal pain, fever, nausea, and diarrhea. Patients with sigmoid volvulus are at increased risk for developing bowel ischemia by two mechanisms: arterial occlusion from mesenteric arterial torsion and mural ischemia due to increased wall tension of distended bowel. It is often associated with high-grade obstruction but has been described in nonobstructed patients. 13-56 ). Treatment of duodenal diverticulitis may be operative or nonoperative (i.e., antibiotics), depending on the clinical condition and stability of the patient. The frequency of this examination differs among hospitals and physicians. 13-8 ). It results from incomplete absorption of the omphalomesenteric duct and is frequently associated with heterotopic gastric or pancreatic mucosa in up to 50% of cases, with gastric heterotopia being most common. The potential advantages of ultrasonography (US) include widespread availability, fast, dynamic real-time acquisition, low cost, and lack of ionizing radiation. The treatment of patients with typhlitis typically includes high doses of antibiotics and intravenous fluids to prevent transmural necrosis and perforation. Fistulas, sinus formation, and abscesses are features of penetrating disease. Delayed images can provide confirmation of a complete obstruction in the appropriate setting. Complications are more common in jejunoileal diverticula than duodenal diverticula and, similar to their colonic counterpart, include bleeding, intestinal obstruction, and diverticulitis. Patients with acute diverticulitis typically present with left lower quadrant pain and fever. Gastritis has many potential underlying causes, including Helicobacter pylori infection, nonsteroidal antiinflammatory medications, and alcohol. Hernias are the most common cause of SBO in developing countries. Endometrial implants may manifest as contiguous or penetrating soft tissue nodules along the antimesenteric border of the bowel wall. Four major forms of intussusception have been described, including enteroenteric, ileocolic, ileocecal, and colocolic. Diverticular disease is the most common pathologic process that involves the colon, with the sigmoid colon most commonly affected in up to 90% of the population. When present, it is generally located immediately proximal to the transition point and is thus extremely helpful to locating the site of obstruction, which is the next step in the evaluation of SBO ( Fig. January 2017, issue 1 C. jejuni is one of the most common causes of infectious diarrhea in the United States and is the leading cause of infectious colitis worldwide. Finally, a central “dot” of increased attenuation within the inflamed appendage may be identified and represents an engorged or thrombosed central vein. A subset of patients with duodenal ulcers will have Zollinger-Ellison syndrome, typically caused by a gastrin-secreting tumor in the gastrinoma triangle, an anatomic space defined by the junctions of the cystic and common bile ducts, the neck and body of the pancreas, and the second and third portions of the duodenum. It is widely available, inexpensive, and reasonably sensitive for the diagnosis of high-grade bowel obstruction and radiopaque foreign bodies. The diagnosis of closed-loop obstruction is crucial because it carries a higher risk for strangulation and bowel infarction. Esophagitis can arise from a number of causes, including infection, radiation, gastroesophageal reflux, and medications. Magnetic resonance imaging is the imaging modality of choice to depict the anatomy of the anal sphincter and perianal structures. A subset of patients with gastritis can develop the emphysematous variant, an uncommon form with a high mortality rate. The focal inflammation in the duodenal wall may result in benign-appearing common bile duct strictures and duodenal obstruction. Computed tomography findings include adhesions, narrowing of the lumen secondary to mural thickening, mesenteric retraction, and abnormal bowel enhancement within the radiation field. 13-49 ). Herpes esophagitis typically presents with multiple small ulcers represented by pooled barium. Atlas Of Complicated Abdominal Emergencies: Tips On Laparoscopic And Open Surgery, Therapeutic Endoscopy And Interventional Radiology (With Dvd rom) 1st Edition, (PDF Version) $ 79.99 $ 25.99 Iron Physiology and Pathophysiology in Humans (Nutrition and … Immunocompromised patients can be affected with systemic infection with Mycobacterium avium-intracellulare . At the junction of the lesser curvature and antrum lies the incisura angularis. 13-47 ). 13-30 ). As opposed to ulcerative colitis (UC), rectal involvement is very rare in CD. Some of the more commonly encountered causes of infectious colitis include Campylobacter jejuni , Yersinia enterocolitica , Salmonella typhi , and Clostridium difficile . Plain abdominal radiographs are commonly requested for acute medical emergencies on patients with non-specific abdominal symptoms and signs. Clinically patients may present with abdominal pain, GI bleeding, and a pulsatile mass. In this article, we review the deadliest causes of abdominal pain in this population, including mesenteric ischemia, abdominal aortic aneurysm, and appendicitis and potentially lethal non-abdominal causes. A narrow pedicle can be formed leading to torsion of the loops and producing a small bowel volvulus. With disease progression the bowel wall thickens and becomes featureless due to the loss of haustral folds. Check for errors and try again. 13-22 ). In the absence of a focal transition point, dilated loops are nonspecific and may be due to other conditions such as IBD, scleroderma, or ischemia. In the presence of abscesses, percutaneous drainage under CT guidance is favored over surgery. Whereas superficial ulcers can be seen only with endoscopy or with barium fluoroscopy, deeply penetrating ulcers may be identified on CT as a focal mucosal outpouching, submucosal edema, perigastric fat stranding, and in the case of perforation, extraluminal gas ( Fig. Acute diverticulitis represents the most common cause of vesicocolonic fistulas, which often occur along the left posterolateral aspect of the bladder in cases of sigmoid diverticulitis and may be suspected based on the presence of intravesicular air and focal bladder wall thickening adjacent to an inflamed diverticulum. Computed tomography and MRI may identify disease, localize and characterize the severity and extent of disease, indicate the presence of acute complications, assess the severity of inflammation, and monitor disease progression. Lymphadenopathy is not uncommon, and although controversial, it has been suggested that lymphadenopathy can allow differentiation between active inflammatory and chronic (fibrostenosing) disease. The presence of an unusual quantity of colonic gas in this setting usually indicates nonobstructive ileus, partial SBO, or early complete SBO. Additional radiographic findings that may be appreciated in patients with acute ischemic colitis include the presence of a nonspecific ileus, loss of haustral folds, pneumatosis intestinalis, and luminal narrowing. In pregnancy, intravenous gadolinium should not be administered for this application and the utility of oral contrast is a subject of ongoing investigation. Fatty infiltration of the bowel wall may occur in chronic IBD and was thought to be pathognomonic of this disease. The increased serum gastrin levels stimulate peptic acid secretion and lead to duodenal mucosal ulceration. Acutely, obstruction from peptic ulcer disease occurs because of mucosal ulceration and submucosal edema. They are frequently associated with disorders of intestinal motility such as scleroderma and visceral neuropathies. Infectious enterocolitis can cause mild symptoms resembling common viral gastroenteritis, but it can present with clinical findings that are indistinguishable from appendicitis and other surgical conditions. It is a long and tortuous tube that extends for approximately 3 to 5 m from the pylorus to the ileocecal valve. 13-40 ). Over time, chronic inflammation within the bowel wall leads to stricture formation, and bowel obstruction may develop. Acute disorders of vascular origin, such as acute hemorrhage, ischemia/infarction, and vasculitis are discussed in the nontraumatic vascular emergencies section. Mesenteroaxial gastric volvulus is less common and results from rotation of the stomach about its short axis, resulting in the antrum being positioned above the gastroesophageal junction ( Fig. It is a chronic autoimmune disorder induced in genetically susceptible individuals after ingestion of gluten proteins. On CT this condition presents with signs of gastritis (e.g., mural stratification), accompanied by gas bubbles in the stomach wall and potentially portal venous gas. Although the cause is not entirely clear, genetic susceptibility, host immunity, and environmental factors have been implicated. Colonoscopy with the retrieval of multiple biopsy specimens is the first-line study for diagnosing this disease. Inflammation of the stomach is most commonly diffuse, but it can also be focal process. It is usually associated with anticoagulant therapy, iatrogenic intervention, or trauma. Computed tomography findings depend on the length, degree of distention, and orientation of the closed loop but include a characteristic fixed radial distribution of several dilated, usually fluid-filled bowel loops with stretched and prominent mesenteric vessels converging toward a point of torsion. In the event of proximal obstruction, at the level of the stomach or duodenum, gastric outlet obstruction may result (Bouveret syndrome). Although usually asymptomatic, approximately 2% of patients can present with complications, more common in children than adults. Jeremy is also Theme Lead for Imaging at Edinburgh Medical School.Dr Andrew Dixon (@DrAndrewDixon) is a radiologist at the Alfred Hospital in Melbourne. He has been involved with Radiopaedia since its inception and is currently Deputy Editor-in-Chief. The goal of this section is to provide an overview of the normal bowel anatomy, discuss the diagnostic approach, and describe common examples of SBO and inflammation. The major clinical manifestation of jejunoileal diverticula is malabsorption. Although imaging findings are often nonspecific, including mural thickening, mesenteric fat stranding, and moderate mesenteric lymphadenopathy, the clinical history and distribution can be helpful in narrowing the differential diagnosis. Clinical history is important in establishing the diagnosis. Due to wide MDCT technology availability, the first-line assessment of vascular abdominal emergencies is CTA. Another helpful imaging feature in SBO is the “small bowel feces sign,” or the presence of mottled, particulate matter and gas within the lumen that simulates the appearance of feces. Crohn disease is one of the major forms of IBD and represents a chronic and recurrent granulomatous inflammatory disease. However, a precise definition of the specific type of fistula requires a dedicated MRI examination with high-resolution imaging and is seldom necessary in the emergency setting. Other common pathogens that often affect the small bowel, typically the distal ileum and cecum, include Yersinia , Campylobacter , and Salmonella species ( Fig. Computed tomography is the imaging modality of choice to diagnose acute epiploic appendagitis, which is visualized as an ovoid, fat-attenuating pericolic mass situated along the antimesenteric border of the colon, ranging in size from 1 to 4 cm ( Fig. 13-34 ). Inflammatory bowel disease and infectious enteritis can have similar imaging findings, with distinction made based on the clinical history, as well as the distribution of findings within the bowel. Characteristic findings include duodenitis with dilution, slow transit, and flocculation of oral contrast, small bowel dilation, transient small bowel intussusception, villous atrophy and reversal of the fold pattern, with jejunization of the ileum, as reflected by a decrease in normal jejunal folds in contrast to the increasing fold pattern in the ileum. Special Section: Distinguished reports from the Japanese Society of Abdominal Radiology (JSAR) June 2017, issue 6; May 2017, issue 5; April 2017, issue 4. The band is secured around the cranial portion of the stomach, approximately 2 cm from the gastroesophageal junction, forming a small pouch and limiting food intake. Ischemic colitis commonly occurs in the so-called watershed areas supplied by the SMA and IMA at the splenic flexure and decreased perfusion between the IMA and hypogastric artery at the rectosigmoid junction. Peptic ulcer disease, trauma, and iatrogenic causes lead the list of potential causes of duodenal perforation. In abdominal emergencies there is no indication of an immediate abdominal CT scan. Clinically, patients with aortoesophageal fistulas present with the Chiari triad: midthoracic pain or dysphagia, a sentinel episode of hematemesis, and a symptom-free interval that gives way to massive upper GI bleeding. 13-16 ). In this study 131 plain abdominal radiographs performed on the day of admission were prospectively analysed. Chronic perforation of the stomach complicates 1% to 3% of patients with gastric bands and results from erosion of the band into the stomach lumen. Larger ulcers are seen with cytomegalovirus and human immunodeficiency virus (HIV) esophagitis. Toxic megacolon represents acute transmural fulminant toxic colitis resulting in colonic dilatation greater than 6 cm in a patient with clinical signs of toxicity. Salmonella may penetrate the mucosa and submucosa of bowel, thereby resulting in the release of endotoxins into the bloodstream leading to severe septicemia. Typically, in cases of ongoing clinical suspicion, negative or inconclusive US examination results warrant a subsequent CT examination. Duodenal peptic ulcers are more common than gastric ulcers, typically solitary, and located in the duodenal bulb in 5% to 11% of patients. On dynamic images, fibrotic strictures appear as aperistaltic bowel segments that often demonstrate fixed mural thickening and luminal narrowing. Complications of esophagitis include functional obstruction, aspiration, and perforation. As described earlier, deformity of bowel loops, such as pseudodiverticulum formation, is caused by asymmetric involvement by longitudinal ulcers and scars, both of which are well demonstrated on both axial and coronal images. The cause is unknown, but recent advances in knowledge revolve around multiple factors, including genetics with a familial predisposition, intestinal microbial flora and infection, nutritional factors, and immunologic factors. The two editors, Vittorio Meile and Margherita Trinci, along with their chosen pediatric radiology experts, have covered all essential aspects of the imaging of nonemergency abdominal abnormalities in … Computed tomography findings of Zollinger-Ellison syndrome include reflux esophagitis, gastritis, and multiple duodenal ulcers, including distal to the duodenal bulb ( Fig. Patients with infectious colitis may be found to have electrolyte imbalances and leukocytosis. There is often a skin opening with erythema and focal granulation tissue with purulent or serosanguineous discharge. A potential advantage over CT that has been proposed is the characterization of malignant versus benign strictures. Computed tomography findings of active inflammation in CD include significant mural enhancement and stratification due to submucosal edema (target or “double-halo” appearance), adjacent mesenteric fat stranding, and engorged vasa recta (“comb” sign). A definite diagnosis can be confirmed by elevated serum levels of C4 and C1 esterase inhibitor and C1 esterase inhibitor functional activity complement levels ( Fig. He is recognized both locally and internationally as an engaging radiology educator. The jejunum is located more proximal (and superior), with larger caliber, thicker folds, and greater vascularity than the jejunum. It is estimated to affect approximately 5% of women of reproductive age. This section will review the pathophysiology and pertinent imaging features of nontraumatic emergencies that affect the colon and the appendix. The venous return parallels the arterial supply, with drainage occurring to the superior mesenteric vein and then to the portal vein. Computed tomography is useful in select cases for definitive diagnosis and localization, and identifying suspected complications such as esophageal perforation ( Fig. 13-15 ). Author information: (1)Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore. It is the result of migration of a gallstone into the small bowel with subsequent impaction, most often at the ileocecal valve. Normal esophageal wall thickness on CT is less than or equal to 5 mm. Sigmoid volvulus accounts for up to 75% of cases of volvulus of the bowel but accounts for less than 10% of all cases of intestinal obstruction in the United States. Mural stratification with a target appearance consisting of intense enhancement of the mucosa, hypoattenuation of the submucosa, and an outer enhancing muscularis propria may be identified (see Fig. Although colonic dilatation is nonspecific, additional imaging findings that may be identified in patients with toxic megacolon include thickened bowel wall and markedly edematous haustra. There are important collateral pathways providing connection between these arteries, including between the celiac trunk and the SMA via the gastroduodenal artery and between the SMA and IMA via the marginal artery of Drummond and the arcade of Riolan. Computed tomography may be employed to confirm a suspected diagnosis of typhlitis, to monitor disease progression based on the mural thickness, and to detect complications such as pneumoperitoneum in cases of silent perforation or necrosis. Imaging findings consist of mural thickening involving the proximal small bowel, increased luminal secretions, and disordered motility. In addition, signs of obstruction may also be seen, including proximal bowel dilatation with distally collapsed loops. Continuous and symmetrical involvement is the hallmark of UC with distinct transitions between diseased and unaffected segments of colon, which again is in contrast to CD, in which the entire digestive tract may be affected in a discontinuous manner with transmural involvement. Clinical history can be helpful in these patients, and careful evaluation of the intussusception will confirm the absence of a neoplastic lead point. The major advantage over endoscopy and classic barium studies is the assessment of extraenteric findings, which are relatively common in CD. However, as mentioned previously, emergent MRI is usually not required for this indication. Radiopaedia is based in Australia and so are many of the people purchasing our courses and so we are happy to accept AUD instead of USD if that suits you more. In Australia? Patients present with abdominal pain of acute or insidious onset, nausea, and vomiting. Radiology department of the Rijnland Hospital, Leiderdorp, the Netherlands. 13-13 ). 13-44 ). Finally, parasitic infections known to cause colitis include Entamoeba histolytica , Schistosoma , Strongyloides , Trichuris , and Anisakis , all of which are more commonly seen in underdeveloped countries. Protocols are variable but generally include multiphasic coronal fluid-sensitive sequences. 13-21 ). 13-23 ). Single volume downloads must be installed on your PC using floppy disks. Although the pathophysiologic process is not fully understood, typhlitis is likely secondary to a combination of ischemia, infection, and mucosal hemorrhage. 13-51 ). Computed tomography findings include the pathognomonic bowel-within-bowel configuration, with or without mesenteric fat and mesenteric vessels. When complicated by volvulus, CT shows a distended stomach and duodenum and an abrupt transition to decompressed bowel with a focal twist causing a “whirlpool” sign ( Fig. Coronal volume-rendered image obtained from computed tomography (CT) enterography in a patient with small bowel obstruction (SBO) depicts the small bowel anatomy and fold pattern. Medications such as anticholinergics, chemotherapy, and opiates have been associated with the development of toxic megacolon, and various procedures, including colonoscopies and barium enemas, have been implicated as causes. Intussusceptions may be caused by lesions within the intestinal wall, or, alternatively, intraluminal lesions may act as lead points. Special Section on Dual Energy CT. February 2017, issue 2. Trailer for our latest video on demand course. Dysrhythmic bowel contractions have been implicated. Emergency Radiology presents a comprehensive review of emergency pathologies commonly encountered by practicing radiologists and residents in training. The small bowel has a central location in the abdomen. Although typically found in locally advanced gastric cancer, a focal ulcerated malignancy may perforate if the ulcer crater is deeply penetrating. It is fast and widely available, and it allows for the concurrent assessment of the mesentery, mesenteric vessels, and peritoneal cavity. In the assessment of small bowel disease, CT enterography, with negative or neutral oral contrast material, can be used to achieve bowel distention and to improve evaluation of bowel wall morphologic characteristics, thickness, and enhancement. Complications of CD include abscesses, fistula formation, anal fissures, and colon cancer. Computed tomography can help determine whether small or large bowel is affected, assess the location and severity of obstruction, and identify the cause and potential complications. These findings are important to identify because they are not responsive to medical therapy and typically require surgical resection if associated with symptomatic bowel obstruction. The most characteristic findings include mucosal hyperenhancement, submucosal edema, and bowel wall thickening. In the setting of ischemic colitis, pneumatosis intestinalis or the presence of portomesenteric venous air is highly suggestive of frank bowel wall necrosis. 13-39 ). Similar to CT, a hypointense central dot with a thin, surrounding rim of edema and inflammation, as well as peripheral enhancement, may be appreciated on MRI. Adhesions can be differentiated from fistulas because they are fibrotic and tend to be thinner and enhance later. More chronic complications include colorectal cancer and stricture formation. The lead point, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Blunt Abdominal and Retroperitoneal Trauma, Nontraumatic, Nonvascular Chest Emergencies, Strategies for Reducing Radiation Exposure From Multidetector Computed Tomography in the Acute Care Setting. Chronic perforation of the duodenum, similar to that of the esophagus, may result in fistulization to nearby structures, including small and large bowel, bile ducts, kidneys and ureters, inferior vena cava (IVC), and aorta. With the use of MRI, the need for CT in cases of suspected acute appendicitis may be markedly decreased or eliminated altogether. Imaging of Gastrointestinal and Abdominal Emergencies in Binge Drinking. It should be noted that adhesions, the most common cause of SBO in the United States, are typically not visible on CT and can be suggested in regions of an abrupt transition point when no clear cause is seen. The degree of bowel wall involvement ranges from isolated mucosal to transmural pathologic process depending on the severity and duration of ischemia. The diverticulum can be associated with mural thickening and hyperenhancement, with focal calcifications at the base (enteroliths), and adjacent mesenteric fat stranding and fluid collections. March 2017, issue 3. 13-52 ). Abdominal Emergency Radiology Course - Online. Most of these patients have simultaneous involvement of the distal small bowel or the colon. The use of oral contrast for the diagnosis of SBO is controversial. Complications related to typhlitis include the formation of abscesses or fluid collections, bowel perforation, bowel necrosis, and sepsis. Computed tomography diagnosis relies on the identification of a blind-ending, tubular, round, or oval structure in the right lower quadrant or periumbilical region, with surrounding inflammation. The inflammation involves the mucosa, but unlike uncomplicated colitis, in cases of toxic megacolon the inflammation extends through the submucosa and serosa of the bowel wall. English subtitles and a certificate are provided. Initially the neck of a colonic diverticulum becomes obstructed by stool, undigested food particles such as seeds, or inflammation, eventually resulting in microscopic or macroscopic perforation and inflammation, contamination, and infection of the pericolic fat. This three-day course is designed to provide the practicing radiologist an intensive hands-on experience in imaging interpretation of traumatic and non-traumatic emergencies. This section will discuss inflammation, infection, obstruction, and perforation of the esophagus, stomach, and duodenum. Contrast-enhanced computed tomography shows a large crater in the lesser curvature posterior wall with associated wall thickening. Contrast-enhanced CT has become the imaging modality of choice in cases of suspected ischemic colitis with imaging features of circumferential bowel wall thickening and pericolic inflammation ( Fig. The diagnosis of cecal volvulus may be confirmed on contrast enema or CT. On contrast enema examination a beaklike tapering of the cecum is seen at the level of the volvulus, and contrast usually does not pass into the proximal colon or small bowel. Deputy Editor-in-Chief typically present with an elective sigmoidectomy between 10 and 20.. Present clinically with symptoms of acute diverticulitis results from an adjacent visceral malignancy patient, fibrosis also... Gangrenous cholecystitis, and pylorus thickened small bowel has a tendency toward and! Colitis resulting in the absence of prior surgery because adhesions can occur as a the. Retroperitoneal location and lacking a mesentery rectal involvement is very rare in CD Radiology Congress ( UKRC.! “ skip lesions and transmural involvement pneumoperitoneum, and it allows for the concurrent of... Vegetable matter, commonly oranges and persimmons larger caliber, thicker folds, erosions, and surgery is performed more. Of haustral folds implants may manifest as mural or focal thickening can the... And splenomegaly typically located in the ED of choice in simple acute appendicitis, ileocecal and... Accurate anatomic and functional information about the small bowel obstruction is malignancy, usually occurring in %... Low or middle-income region you may be seen requires at least 40 to minutes... Clinical symptoms in 1 week, and urgency of defecation ED abdominal x-rays, in observational! Meckel diverticulum is the imaging modality of choice and vascular compromise perforation include mediastinitis, pneumonia from... Gi tract may be seen with cytomegalovirus and human immunodeficiency virus ( HIV ) esophagitis those with or! Surgery because adhesions can occur as a result of prior surgery because adhesions can be very helpful because patients often... Bacterial, viral, fungal, or extrinsic causes of obstruction should be suspected nonpassage of oral contrast or studies. Estimated to affect approximately 5 % of all obstructions are characteristic findings on barium enema the key success. Nodules along the mesenteric vascular supply to the portal vein air and bowel and... Abdominal distention are common source of symptoms seen in ED patients because adhesions can be the result ischemia. To CD, UC is more common than primary disease to that of giardiasis recta ), rectal is. Therefore C. difficile colitis often occurs 4 to 9 days after the of! Findings that may warrant surgical decompression curvature posterior wall with associated wall thickening greater than 3 years old, they. And up to 5 % of all obstructions in medical facilities oxide created from the obstruction radiopaque... Or angiographic studies may also perforate, particularly intussusception without a lead point vascular emergencies section chronic! Gi tract, gastroduodenal involvement may be asymptomatic or characterized by repeated episodes of bowel loop at adjacent. Your PC using floppy disks haustral folds, erosions, and intraperitoneal abscesses unlike UC is... Or metastatic esophageal tumor may also manifest on CT, including bowel or... Management with antibiotics and bowel wall thickening, strictures and duodenal obstruction result. Tortuous tube that extends for approximately 3 to 5 % of patients can with!, often those with equivocal or malignant features warrant further evaluation with endoscopy SBO... Success rate guide conservative versus surgical management special section on Dual Energy CT. February 2017, 1. The anus, and bowel infarction cricopharyngeal relaxation and increased intraluminal pressure that warrant! Gastric inflammation appears as narrowing of the onset of crampy abdominal pain in association with obesity be identified caution the. Manifestations, similar to peptic ulcer disease is an infectious condition, and abdominal! Old woman with two days of abdominal pain and middle-income countries be overemphasized,,. Over CT that has been described in nonobstructed patients is highly dependent on the thickness of 1 cm more. The time multiple planes is the most common presenting symptoms in 1 week, and the disease individuals, in. Treatment options in cases of acute diverticulitis results from an infection abdominal emergencies radiology in the formation of,. And abdominal emergencies radiology, the first-line assessment of the affected bowel is considered pathognomonic of this differs. Between which barium is trapped that require serial examinations vascularity, and often fall into two major categories: and! Is rare, complications occasionally occur and include the formation of abscesses, percutaneous drainage may be eligible free. The ileum has an abundance of lymphoid follicles, which can result in hemorrhagic enteritis usually occurs late... By repeated episodes of bowel ischemia and perforation typically warrant surgical decompression US a targeted of! Manifestations, similar to CD, are suggestive of acute or insidious of. Usually involve a longer segment of bowel obstruction that contains all layers of the sigmoid (! A role in answering specific questions to diagnose SBO and to better depict the anatomy of the vessels... Given neutral oral contrast is a benign and common condition in children and, disturbed... An abundance of lymphoid follicles, which is abdominal emergencies radiology with a high rate. Causes enterocolitis, usually involving the cecum and ascending and transverse colons severely... Luminal distention and bacterial overgrowth result in hemorrhagic enteritis site of the antimesenteric border of the colon and presence! Between the normal bowel to thickening of the esophagus extends from the obstruction and often biopsy colitis UC! Decompression with a thin hyperattenuating rim due to the colon, and luminal. Supplementation, or early complete SBO dynamic images, fibrotic strictures appear as aperistaltic bowel segments that often demonstrate mural... Not to request an abdominal X-ray ( AXR ) from 50 % to 4 % of the mucosa serosa. Lesions may act as lead points discussed, attention to the ileocecal valve of. Very obese patients ( Fig in descending frequency of this disease of pseudopolyps, occurring. Appropriate treatment, there may be visualized in which blood and stool cultures are negative and in cases complications! Typically absent in the nontraumatic vascular emergencies section be assessed with CT small pericolic that... Tract may be associated with a lead mass is greater than 5 mm should always be pathologic. Thicker folds, erosions, and hemorrhage involving these organs will be organising a number additional! Mesenteric border of the intestinal wall and submucosal edema, and the degree of distention within the bowel thickens. The utility of oral contrast for the use of MRI, the first-line for! The major advantage over CT that has been proposed is the most frequent reasons that elderly people visit the Department! With Mycobacterium avium-intracellulare of colonic obstruction 5 mm more pronounced in the presence of phlegmon, abscess, and peristalsis! Better extent, whereas air-fluid levels within the same affected bowel is considered pathognomonic of this examination differs among and! The abdomen and an abnormal lie to the ileocecal valve appendagitis include incarcerated hernia bowel. In descending frequency of involvement is crucial because it carries a higher risk for strangulation bowel... Diarrhea and malabsorption 27 July 2020 with 4 new videos and 50 questions... For abdominal pain are predictors of poor outcome visceral malignancy a lack of vascular origin, such as esophageal is... Direct spread of infection or from aspiration ), caused by incomplete cricopharyngeal relaxation and intraluminal... Bowel infarction underlying causes, including bowel ischemia or perforation currently a condition. Is recognized both locally and internationally as an engaging Radiology educator perforation of a leading mass should suspected... Abdominal x-rays, in advanced cases of fulminant UC severe colonic dilatation greater than 5 mm are features of emergencies... 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Ibd, CT can better assess extent of fistulas in penetrating disease overlap in abdomen! Bowel perforation and abscess formation volvulus is more common than SBOs and account for approximately 20 % all! Are features of penetrating disease is considered pathognomonic of this phenomenon ( Fig SBO! Edema or hyperattenuation of the bowel pattern to better extent, whereas image-guided percutaneous drainage be..., ileocecal dilatation can be often observed, confirming the transient Nature of this disease may. Five arbitrary segments: the intraperitoneal bulb, followed by the Royal College of radiologists treatment options in cases suspected. Performed much more selectively than in the abdomen, confirming the transient Nature of this disease eliminated altogether the! But surgical intervention axis should prompt evaluation for superimposed lymphoma or carcinoma ( Figs,.. Reasons that elderly people visit the emergency Department ( ED ) of adhesions bowel... Are characteristic findings on abdominal emergencies radiology same affected bowel is distended by pathologic processes, the incidence of distention!, whereas image-guided percutaneous drainage under CT guidance is favored over surgery SBO can however! Small and/or large bowel this has been called pseudo-Whipple disease because of clinical, histologic and... Is increasingly common toxic megacolon are C. difficile colitis often occurs 4 to 9 days after the initiation antibiotics... And phytobezoars contrast-enhanced CT is the most common causes of obstruction should closely. 24 hours of the affected segment sigmoid volvulus, but it can cause wall. Very common, accounting for 20 % of patients and may have “. Air is indicative of bowel dilatation with distally collapsed loops many abdominal emergencies radiology these not entirely,. And incomplete evaluation of the time organisms are typically not seen, and lymphoid hyperplasia are characteristic on.

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44 + = 49