Jeanne W. Baer

Cost-effectiveness and patient tolerance of low-attenuation oral contrast material: Milk versus volumen

OBJECTIVE The purpose of our study was to prospectively compare the cost, effectiveness, and patient tolerance of milk and VoLumen, a 0.1% barium suspension, in patients undergoing abdominal and pelvic CT with oral and i.v. contrast media. SUBJECTS AND METHODS Two hundred fifteen consecutive outpatients were randomly assigned to receive either whole milk (n = 115) or VoLumen (n = 100). Results were independently reviewed by two radiologists who were blinded to the oral contrast agent used. Degree of bowel distention was qualitatively scored on a 4-point scale, and bowel wall visibility was graded qualitatively on a yes-or-no basis. A questionnaire regarding oral contrast tolerability was provided to each patient. Cost comparison of the two agents was performed. RESULTS No statistically significant differences were seen between whole milk and VoLumen with respect to degree of bowel distention and mural visualization for all segments of bowel studied (p > 0.05 for both reviewers). Significantly more patients ranked milk as pleasant in taste compared with VoLumen (p < 0.0001). More patients preferred milk compared with VoLumen (p < 0.0001). Milk was better tolerated than VoLumen, with fewer abdominal side effects, including abdominal discomfort (p = 0.019), cramping (p = 0.019), nausea (p = 0.016), and diarrhea (p = 0.0002). The cost per patient for VoLumen is

Hepatic arterioportal fistula related to a liver biopsy.

18 compared with

Hemorrhagic pancreatitis: A complication of transcatheter embolization treated successfully by total pancreatectomy

1.48 for milk. CONCLUSION Whole milk is comparable to VoLumen with respect to bowel distention and bowel wall visualization and has a lower cost, better patient acceptance, and fewer adverse symptoms. Milk is a cost-effective alternative to VoLumen as a low-attenuation oral contrast agent.

Right hepatic artery as a cause of pseudocalculus in the biliary tree

A case of hepatic artery portal fistula, presenting with bleeding esophageal varices five months following a liver biopsy for cirrhosis, is presented. The angiographic features of the lesion are illustrated and the pertinent literature concerning etiology of hepatic arterioportal shunts is reviewed.

Extraperitoneal mass effect by ascites under tension

Since pancreatitis can be produced experimentally in dogs by embolization of microspheres into the pancreatic arterial circulation, there has been speculation that intentional or inadvertent embolization of the pancreas in human subjects could also produce pancreatitis. Although such therapeutic embolization has increased, no pathologically documented case of this complication has been recorded. We have reported the first such case occurring in a patient with a large, highly vascular, nonfunctioning islet cell carcinoma of the tail of the pancreas preoperatively embolized with Gianturco coils and Gelfoam particles suspended in sodium tetradecylsulfate solution to facilitate distal pancreatectomy. The resultant hemorrhagic pancreatitis and duodenal necrosis required a total pancreatectomy. We conclude that, by itself, occlusion of the origin of the splenic and gastroduodenal arteries with coils would have been effective and without complication; however, the addition of Gelfoam particles in a sclerosing solution reduced the microscopic pancreatic circulation to a critical point and resulted in hemorrhagic pancreatitis.

Transgastric esophageal bougienage via a feeding gastrostomy

The right hepatic artery (RHA) may be the cause of a pseudocalculus in the common hepatic duct (CHD). Extrinsic pressure by the RHA on the CHD was seen in 15% of 61 retrograde cholangiograms and in 70% of 23 sonograms in which the RHA was identified. The anatomical relationship between the RHA and the CHD was confirmed by cast corrosion studies.

Gastric varices appearing as intraluminal masses on computed transaxial tomography.

Benign ascites may cause an extraperitoneal mass effect when it becomes loculated by adhesions or when peritoneal recesses are enlarged by ascites under tension. Five symptomatic patients were examined by computed tomography demonstrating ascites as the cause of an apparent mediastinal mass in 1, a retrogastric mass in 1, and a retroperitoneal mass displacing the right kidney anteriorly in 4.

Calcifications within the duct of Wirsung in calcific pancreatitis.

Peroral bougienage of the esophagus is effective for the dilation of most esophageal strictures. In some patients, the stenosis may be so severe that neither dilator nor guide wire can pass. Previously, surgical therapy has been necessary to relieve the stenoses in such patients; however, the patients frequently are poor surgical risks because of their nutritional status and advanced age. We have developed a technique of bougienage through a feeding gastrostomy, which has allowed the successful endoscopic treatment of two such patients.

Abstracts Papers presented at the Eleventh Annual Session of the Society of Gastrointestinal Radiologists, October 1, 1981, Boca Raton, Florida

Two case reports are presented to demonstrate that submucosal and subserosal gastric varices can appear as intraluminal masses on computed transaxial tomographic images.

An Unusual Case of Adenocarcinoma of the Pancreas

A review of abdominal radiographs of 50 patients with the clinical diagnosis of chronic pancreatitis showed calcific pancreatitis in 27 patients. Ten patients had severe pain associated with weight loss. Five had obstruction of the duct of Wirsung: one by a pseudocyst and four by large stones near the ampulla of Vater. The radiologic workup presented emphasizes the need to study the duct of Wirsung in patients with chronic pancreatitis to guide the surgical approach for relief of intractable pain. Theories regarding the pathophysiology of calcium deposition and stone formation and migration are reviewed.