David Frager

Role of CT in evaluating patients with small-bowel obstruction

The accurate and rapid diagnosis of acute small-bowel obstruction has troubled surgeons and radiologists for more than a century. With the advent of CT, solving the problem is now a possibility. CT can accurately diagnose obstruction, determine the likely cause and location, and even suggest whether there is associated bowel ischemia or strangulation.

Prospective evaluation of colonic obstruction with computed tomography.

Abstract.Background: To determine whether computed tomography (CT) can satisfactorily diagnose and evaluate patients with suspected colonic obstruction. Methods: Seventy-five patients with suspected colonic obstruction were evaluated prospectively by CT and compared with the gold standards of surgery and/or endoscopy in 65 patients, clinical course in nine, and contrast enema (CE) in one. A limited comparison between CT and CE (26) patients was also made in those patients who had both studies. Results: CT successfully diagnosed colonic obstruction in 45 of 47 patients (96% sensitivity). Pseudo-obstruction was correctly diagnosed in 26 of 28 patients (93% specificity). CT correctly localized the point of obstruction in 44 of 47 patients (94%). CE successfully diagnosed obstruction in only 20 of 25 patients (80% sensitivity). Conclusion: In this study, CT proved to be a satisfactory modality in evaluating patients with suspected colonic obstruction. CT may in certain circumstances be preferable to the traditional CE in evaluating these patients.

Intestinal obstruction: Role of CT

CT has significantly advanced the evaluation of small and large bowel obstruction, especially in the acute situation where high-grade or possibly strangulating obstruction is being encountered. Any physician involved in evaluating patients with bowel distention and abdominal pain where obstruction becomes a distinct diagnostic possibility should be aware of the attributes and limitations of this modality to provide the best patient care. New technological advances will hopefully limit radiation exposure and provide even more definitive information in the diagnosis of bowel obstruction.

Use of magnetic resonance urography

OBJECTIVES Magnetic resonance urography (MRU) is a new technique that uses heavily weighted T2 coronal images with fat suppression pulse. Urine appears white on MRU, resembling an intravenous urogram (IVU). Contrast agents are not necessary. This study describes the use of MRU in the diagnosis and treatment of patients with hematuria. METHODS One hundred six patients with microscopic or gross hematuria and 6 normal volunteers underwent MRU between 1992 and 1995. A modified, heavily weighted T2 technique with intravenous administration of furosemide and ureteral compression was used. Thirty-two patients had other imaging techniques as well for comparison. RESULTS MRU provided high-resolution images in almost all cases; 73 (69%) had a normal MRU. Significant findings in the 33 patients with abnormalities included renal cysts in 17 (51%), renal cell carcinoma in 6 (18%), transitional cell carcinoma in 5 (15%), ureteropelvic junction obstruction in 3 (9%), and stones causing obstruction in 6 (18%). Five patients with renal failure also had good visualization of the entire urinary tract. MRU was comparable to other imaging modalities except in identifying nonobstructing calculi. CONCLUSIONS MRU provides an alternative to conventional imaging of the urinary tract, especially in those patients who have contraindications to ionizing radiation and contrast agents. Improvements in resolution, technique, and cost have to be addressed before it can be used regularly in urologic practice.

Internal hernia complications of gastric bypass surgery in the acute setting: spectrum of imaging findings

Bariatric surgery is increasingly becoming an option for the treatment of morbid obesity. Patients who have undergone gastric bypass surgery have varied post-surgical complications which present acutely in the emergency medical setting, particularly internal hernias. It may be difficult to identify an internal hernia in the absence of intestinal obstruction. This article will review the various types of imaging presentations to highlight the complexity of making a radiographic diagnosis. Recognition of internal hernia as the cause of intermittent or acute abdominal pain symptoms in these patients in the emergency setting can prompt immediate surgical intervention, thus avoiding life-threatening outcomes.