Hatice Gümüş

A rare cause of intestinal obstruction in the adult: Morgagni's hernia

Morgagnis hernia is a rare congenital diaphragmatic herniation and is usually diagnosed in childhood. It is quite rare in adults, and intestinal obstruction as a complication due to intrathoracic intestinal herniation rarely occurs. We present the plain radiography and computed tomography findings of an adult patient with acute abdomen symptoms due to Morgagnis hernia.

Intussusception in Adults

Abstract To review clinical, radiological and histopathological findings of adult intussusception and its management, 18 adult patients who had been treated surgically because of intussusception were reviewed. Of the patients, 5 (27.8%) had idiopathic intussusceptions, while the other 13 (72.2%) had a definable intraluminal pathology. The site of the intussusception was more common in the small bowel (83.3%) than the colon (16.7%). Ultrasonography and computed tomography were successful in demonstrating “target lesion” in 80% and 75% respectively. Patients with idiopathic intussusception were treated with simple reduction, while the others underwent segmental resection because of the possibility of malignant tumour. In contrast to intussusception in childhood, intussusception in adults usually has a definable lead point and resection of the involved bowel, rather than simple reduction, is indicated.

Diameters of the common bile duct in adults and postcholecystectomy patients: A study with 64-slice CT

This study aims to collect data by multidetector computed tomography (MDCT) on the diameter of the normal common bile duct (CBD) and the diameter of CBD after cholecystectomy. In this retrospective study, CBD measurements were performed on axial oblique images, perpendicular to the long axis of the distal CBD. The mean diameter of the normal CBD was measured in 604 patients without cholecystectomy. The patients were divided into 6 groups according to their age. Analysis of variance (ANOVA) was used to compare data obtained from the six age groups. The mean diameter of the CBD of 46 patients who had cholecystectomy was calculated. The results were compared with age matched control group by Students t test. The largest diameter of CBD ranged from 1.8 to 11.8mm. The mean of the largest diameter of 604 subjects was 4.77 ± 1.81. The diameter of the CBD significantly increased with age. Mean largest CBD diameters of postcholecystectomy subjects (7.28 ± 2.37) were significantly greater than age matched control group. In conclusion the diameter of CBD shows a considerable increase with age. The largest diameter of the CBD is up to 6mm in most of the subjects. An upper limit of 8mm appears reasonable after the age of 50; and an upper limit of 10mm seems appropriate for cholescystectomized subjects.

A serious medicolegal problem after surgery: gossypiboma.

AbstractAfter surgery, the most common foreign bodies retained in the abdominal cavity are the surgical sponges. The aim of the present study was to emphasize the importance of gossypiboma, which is a serious and medicolegal problem. The records of 12 patients with a confirmed diagnosis of gossypiboma after abdominal surgery at Dicle University Hospital were retrospectively reviewed between January 1994 and December 2009. Eight of the 12 patients were females, and 4 were males. Previously, 7 patients had been operated on electively, and 5 had undergone operations on an emergency basis. Abdominal ultrasonography clearly demonstrated gossypibomas in 5 patients, and computed tomography demonstrated a more precise image of retained surgical sponges in 3 patients. One patient died because of ventricular fibrillation; the other 11 patients were discharged in good health. To eliminate the risk of gossypibomas, all sponges should be counted at least twice (once preoperatively and once postoperatively); use of small sponges should be avoided during laparotomy, and only sponges with radiopaque markers should be used. The surgeon should explore the abdomen before closure. In cases in which the sponge count is uncertain, an abdominal x-ray should be performed before closure.

Unusual Noncommunicating Isolated Enteric Duplication Cyst in Adults

Duplication cysts are rare gastrointestinal congenital abnormalities and can occur anywhere within the gastrointestinal tract. Duplication cysts are firmly attached to or share the wall of the alimentary tract and have a common blood supply with the adjacent segment of the bowel. Completely isolated duplication cysts are an extremely rare variety of gastrointestinal duplications with their own exclusive blood supply, and they do not communicate with the intestine. These cysts are usually diagnosed during early childhood, and very rarely detected in adults, mostly incidentally, due to a lack of symptoms. A 28-year-old male was admitted to our hospital with a chief complaint of lower abdominal pain and distention and a palpable mass for 1 month. Based upon computed tomography and sonographic findings, a small bowel duplication cyst was tentatively diagnosed. The cyst had no connection to the gastrointestinal tract. Herein we report the case of a noncommunicating isolated ileal duplication cyst in an adult. Resection of the cyst was performed safely without requiring bowel resection.

A Wandering Spleen Presenting as an Acute Abdomen: Case Report

BACKGROUND A wandering spleen, defined as a spleen without peritoneal attachments, is a rare entity characterized by splenic hypermobility due to laxity or maldevelopment of the supporting splenic ligaments. Patients with a wandering spleen may be asymptomatic, or may present with a palpable mass in the abdomen, or with acute, chronic, or intermittent symptoms due to torsion of the wandering spleen. Because early clinical diagnosis is difficult, imaging modalities play an important role in the diagnosis. Treatment should be planned according to the vitality of the spleen. CASE REPORT A 22-year-old woman presented with an acute abdomen that was found to be due to a wandering spleen with 720° anti-clockwise torsion around the pedicle. CONCLUSIONS Splenectomy is advocated in the presence of torsion, splenic vein thrombosis, or splenic infarction. Conversely, when a viable wandering spleen is found at laparotomy, detorsion with splenopexy is preferred.

Percutaneous removal of sentinel lymph nodes in a swine model using a breast lesion excision system and contrast-enhanced ultrasound

AbstractObjectivesTo investigate the feasibility of percutaneous removal of the entire sentinel lymph node (SLN) in an animal model using a breast lesion excision system after identifying these nodes using contrast-enhanced ultrasound (CEUS) and intradermal microbubbles.MethodsAnimal studies approval was obtained. SLNs were identified using CEUS and intradermal injection of microbubbles in two young pigs. Microbubbles were mixed with blue dye and injected around the mammary papillae to access lymphatic drainage to the superficial inguinal lymph nodes. When enhancing nodes were identified, the breast lesion excision system (BLES) was used to remove these nodes percutaneously. Both animals then underwent surgical lymph node dissection. Histopathological examination of all the samples was performed.ResultsRemoval of the entire SLN was successful in three groins in the pigs. All three nodes were stained with blue dye. No other stained nodes were observed in the node dissection specimens. The nodal architecture of removed lymph nodes was well preserved on microscopy. There were no signs of excess trauma within the biopsy bed.ConclusionThe results obtained from the swine model demonstrated that it is feasible to remove the entire SLN percutaneously under the guidance of CEUS and microbubbles.Key Points• Intradermal injection of microbubbles and CEUS can identify sentinel lymph nodes • Ultrasound could then guide percutaneous removal of intact and complete SLNs • We have shown this was feasible in pigs but not yet in humans • This technique may eventually have the potential to reduce futile SLN biopsies.

How Long Will I Be Blue? Prolonged Skin Staining Following Sentinel Lymph Node Biopsy Using Intradermal Patent Blue Dye

Background: Blue dye used for sentinel lymph node biopsy (SLNB) in breast cancer patients may cause prolonged skin discoloration at the site of injection. The aim of this study was to assess the duration of such skin discoloration. Patients and Methods: 236 consecutive patients who had undergone breast conserving surgery and SLNB for breast cancer were reviewed prospectively from January 2007 to December 2009. Results: Of the 236 patients, 2 had undergone bilateral surgery, and 41 had been examined in consecutive yearly reviews. Blue discoloration remained visible at the injection site after 12, 24, and > 36 months in 36.5, 23.6, and 8.6% of the patients, respectively. Conclusion: The use of patent blue for identification of the sentinel lymph node in patients undergoing breast cancer surgery may result in prolonged discoloration of the skin at the injection site.

Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography.

ZusammenfassungDie Lungenvenen sind eine der bedeutendsten Strukturen des Kreislaufs. Im letzten Jahrzehnt wurde erkannt, dass die Lungenvenen eine bedeutende Rolle beim Vorhofflimmern als auslösender Fokus der elektrischen Aktivität spielen. Die primäre Behandlungsmethode des Vorhofflimmerns ist die Ablation des Fokus in den Lungenvenen. Für den besten Erfolg dieser Maßnahme sollte die Anatomie der Lungenvenen vorher gut bekannt sein. MATERIAL UND METHODEN: In unserer Abteilung für Radiologie wurde zwischen Jänner 2008 und Mai 2010 bei 783 Patienten eine computertomographische Angiographie durchgeführt. Die Patienten waren zur Coronar-CT wegen einer bekannten oder suspizierten koronaren Herzerkrankung, bzw. zur CT Angio wegen des Verdachtes auf Pulmonalembolie zugewiesen worden. Alle Untersuchungen wurden auf einem Phillips Brilliance 64 Zeiler Multidetektor CT Gerät durchgeführt. 402 der Patienten waren männlich, 381 weiblich. Das mittlere Alter der Patienten lag bei 48 (14–89) Jahren. Die CT Ergebnisse zur Identifikation der Anatomie der Lungenvenen (inklusive ihrer Varianten und Anomalien) wurden retrospektiv erhoben. ERGEBNISSE: Bei dem Großteil der Fälle mündeten zwei Lungenvenen in den linken Vorhof auf jeder Seite. 18 Variationen wurden rechts und 8 Variationen links entdeckt. Die häufigste kombinierte Variante waren 2 rechts und 4 links (32,3 %) einmündende Lungenvenen. Vier links einmündende Lungenvenen war der häufigste Einfach-Variations Typ (76 %). Zusätzlich wurden ein Situs inversus totalis (0,12 %), 2 partiell anormale pulmonal venöse Rückströme (0,25 %) und ein Szimitar Syndrom (0,12 %) gefunden. SCHLUSSFOLGERUNGEN: Diese Studie zeigt, dass viele Variationen der Lungenvenen mit zunehmender Patientenzahl beobachtet werden. Um eine erfolgreiche und komplikationslose Ablation bzw. Operation zu gewährleisten, sollte die Anatomie der Lungenvenen vor der Prozedur bekannt sein. Die Multidetektor CT ist eine verlässliche bildgebende Methode für die Erfassung der Querschnitts und 3-dimensionalen Anatomie.SummaryPulmonary Veins are one of the major structures of circulation. In the last decade, pulmonary veins have been known to play an important role as the triggering focus of the electrical activity in atrial fibrillation. Primary treatment method of AF is RF ablation of the focus. For the best ablation, the anatomy of PVs should be well established before the procedure. MATERIAL AND METHODS: In our radiology department, 783 patients underwent computed tomography angiography between January 2008 and May 2010. Patients were referred for coronary CTA because of known or suspected coronary artery disease or computed tomography pulmonary angiography (CTPA) because of known or suspect pulmonary embolism. All scanning was performed on Philips Brilliance 64 slice Multidetector CT. The group consisted of 402 male and 381 female patients with the average age of 48 (range 14–89). CT data of patients were retrospectively reviewed to identify the PV anatomy and to determine anatomic variants and anomalies. RESULTS: In the majority of cases, two pulmonary veins drain into the left atrium on each side. Eighteen and eight variations were found in the right and left sides, respectively. Most frequent combined variations were 2R-4L (32.3%) and 4L was the more frequent single variation type (76%). In addition to that one Situs inversus totalis (0.12%), two partial anomalous pulmonary venous returns (0.25%) and one scimitar syndrome (0.12%) were found. CONCLUSION: This study showed that multiple types of variations of PVs can be found with increasing patient number. Therefore, for the successful ablation and surgery without any complications, the anatomy of PVs should be known before the procedure. MDCT is a reliable imaging method for the detailed cross-sectional and 3D anatomy.

Clinical and multidetector computed tomography findings of patients with median arcuate ligament syndrome

OBJECTIVES The present study aimed to present the clinical and multidetector computed tomography (MDCT) findings of patients who were diagnosed with the median arcuate ligament (MAL) syndrome on MDCT retrospectively. METHODS Seven hundred forty-four patients in whom MDCT angiography was performed were retrospectively analyzed for investigating incidental MAL syndrome. RESULTS Twenty-one patients were shown to have MAL syndrome. Of 21 patients, 18 with MAL syndrome were asymptomatic. Three patients had some symptoms. On MDCT angiography, proximal narrowing of the arteries was observed in 21 patients. CONCLUSIONS MDCT is a minimally invasive and useful tool for the diagnosis of MAL syndrome.