Jean-Michel Bruel

Acute abdomen of unknown origin: Impact of CT on diagnosis and management

A prospective study was performed including 40 patients with an acute abdominal syndrome presenting difficulties in defining the etiology. All patients underwent an emergency computed tomographic (CT) scan. The CT scan made the syndromes diagnosis in 95% of cases and it permitted the detection of a lesion in 57.5% of cases. The diagnostic impact of CT scan was significant (p<0.01). The value and the specific contribution of CT in various diseases were analyzed. CT allowed appropriate therapeutic decisions in 95% of cases where clinical examination performance was positive in only 60% of cases. We had two negative CT results leading to an inappropriate therapeutic decision; it consisted of two cases of undiagnosed appendicitis. CT modified the primary therapeutic strategy in 30% of cases and avoided seven laparotomies.

Helical CT of large bowel obstruction.

Although large bowel obstruction (LBO) is four to five times less common than small bowel obstruction (SBO), it is a frequent problem and accounts for approximately 2–4% of surgical admissions for acute abdominal conditions. Because of significant limitations in the clinical and initial radiologic evaluations, with the development of computed tomography (CT) for examination of the acute abdomen, the role of CT in the diagnosis and assessment of bowel obstruction has expanded. This role has been stressed mainly for the diagnosis and management of SBOs [1–5]. As with SBO, the ideal method for evaluating patients with suspected LBO should be relatively noninvasive and capable of answering the following questions defined by Mondor et al. [6]:

Role of CT in the acute nontraumatic abdomen

The diagnostic workup of the acute abdomen always begins with a precise clinical history, a complete physical examination, and careful reading of plain films. Commonly performed additional imaging studies include contrast examination and, more recently, ultrasound. CT offers the advantage of allowing a comprehensive diagnostic evaluation of both solid and hollow viscera in neoplastic as well as in inflammatory and vascular disorders.

Flow-independent magnetic resonance venography of the calf.

To show that flow‐independent venography that exploit the intrinsic MR properties of blood to isolate vessels from surrounding structures can be used for depiction of peripheral veins and for detection of deep venous thrombosis (DVT).

Prise en charge de l’hémorragie d’origine diverticulaire

Aucune publication avec série prospective et randomisation n’a été publiée dans la littérature sur la question de la prise en charge de l’hémorragie diverticulaire. Peu d’articles font état de l’hémorragie diverticulaire en tant que telle mais plutôt de la prise en charge de l’hémorragie digestive basse. En effet, les rectorragies sont la cause la plus commune d’hémorragie aiguë gastro-intestinale basse nécessitant souvent une hospitalisation pour une évaluation diagnostique rapide associée à une prise en charge thérapeutique adaptée.

11 Current CT/MRI examination of the upper intestinal tract

When properly performed, CT of the abdomen can provide valuable information about mural diseases of the alimentary tract. It can demonstrate the digestive origin of an abdominal mass, categorize a given lesion on the basis of its specific CT appearance and any associated CT findings, assess the extramural spread of gastrointestinal lesion, guide various interventional procedures (biopsy, drainage) and follow a patients response to therapy.

Cholécystites aiguës révélatrices de l'hépatite à virus A. A propos de 2 cas

Two patients presenting with hepatitis A had initial clinical onset associated with ultrasonic or CT abdnormalities suggestive of acute cholecystitis. It has very rarely been reported.