Norman Joffe

Primary carcinoma of the gallbladder associated with chronic inflammatory bowel disease

Patients with chronic inflammatory bowel disease have an increased risk of developing carcinoma of the bile ducts. This risk is highest in those with a long history of colitis and total involvement of the colon. The majority of these biliary tract cancers involve the extrahepatic or intrahepatic bile ducts. Occasionally, however, the gallbladder is the site of origin of the tumour. We report three cases of primary carcinoma of the gallbladder complicating chronic inflammatory bowel disease. In two, there was universal chronic ulcerative colitis and in one, Crohns ileocolitis.

Radiographic appearances and course of discrete mucosal ulcers in Crohn's disease of the colon.

Although the radiographic manifestations of Crohns disease of the colon have been extensively reviewed, few reports specifically illustrate the evolution of discrete mucosal ulcers in this disease. There is, moreover, some controversy concerning the nature and significance of small or so-called aphthous ulcers in the pathogenesis of Crohns colitis. In this study, results from sequential primary double-contrast barium enemas performed over a 5-year period in 21 patients with proven Crohns colitis were reviewed. A localized segment of colon showing discrete mucosal ulcers was selected for analysis and comparison in serial examinations. The radiographic appearances and course of these discrete mucosal ulcers are described and illustrated.

Gas-Forming Clostridial Mycotic Aneurysm of the Abdominal Aorta: A Case Report

Gas-forming mycotic aneurysms are extremely rare. A case is reported in which rupture of a gas-forming mycotic aneurysm of the distal abdominal aorta due to Clostridium paraputrificum occurred in an elderly male with a myeloproliferative disorder and a necrotic carcinoma of the colon.

Transpyloric Prolapse of Polypoid Gastric Carcinoma

Four patients with discrete intraluminal filling defects in the duodenal bulb secondary to transpyloric prolapse of polypoid gastric carcinoma are reported. The lesions were pedunculated in 2 cases and sessile in the remaining 2. The clinical, radiological,and pathological findings are discussed. Prolapsed gastric carcinoma should be included in the differential diagnosis of localized intraluminal filling defects in the duodenal bulb and endoscopy and biopsy performed in patients with appropriate clinical and radiological findings.

Barium Studies in Small-Bowel Infarction

Seven patients with proved small-bowel infarction were studied to determine whether the radiographic appearance of an ischemic segment is helpful in predicting the severity of the process, in particular the potential viability or nonviability of the affected bowel. It was found that the barium examination is useful in detecting small-bowel infarction in clinically obscure cases but is unreliable in predicting the depth of necrosis or potential viability of an ischemic segment. In addition, the longitudinal extent of ischemic damage was underestimated using the radiographic findings and there was poor correlation between the transit time of barium and the severity of bowel-wall damage.

Symptomatic gastrointestinal metastases secondary to bronchogenic carcinoma

Gastrointestinal metastases secondary to bronchogenic carcinoma are relatively uncommon and most are found incidentally at autopsy examination in patients with advanced or widely disseminated lung cancer. Occasionally gastrointestinal metastases occurr relatively early in the course of the disease and give rise to a variety of clinical symptoms and radiological abnormalities. Recognition of these abnormalities is important in order that appropriate palliative therapy may be undertaken. The clinical. radiological and pathological findings in 12 patients with symptomatic gastrointestinal metastases secondary to bronchogenic carcinoma were reviewed. Clinical symptoms varied according to the site of metastatic involvement and included dysphagia, epigastric pain, nausea, vomiting, gastrointestinal bleeding, anaemia and signs of intestinal obstruction or perforation. The sites of metastatic involvement were: oesphagogastric junction (2 cases); stomach (2 cases); duodenum (1 case): jejunum (3 cases); ileum (2 cases), colon (2 cases). The radiological findings are discussed and illustrated.

Roentgenologic aspects of chronic perforating carcinoma of the colon: Report of five cases

SummaryThe clinical and roentgenologic findings typical of annular carcinoma of the colon are well known, and the diagnosis of this lesion is usually straightforward. However, when there is perforation of the neoplasm through the intestinal wall with the development of secondary inflammatory changes, both the clinical and roentgenologic features may be altered, and the correct diagnosis becomes more difficult to determine preoperatively. Some clinical and roentgenologic aspects of this type of chronic perforating carcinoma of the colon are discussed, using five selected cases as examples.

Right-angled narrowing of the distal oesophagus secondary to carcinoma of the tail of the pancreas

Dysphagia due to secondary involvement of the oesophagus by pancreatic carcinoma is relatively rare. Occasionally, the oesophagus may be involved by direct extension of a carcinoma of the body and/or tail of the pancreas or metastatic lymphadenopathy in the posterior mediastinum. Although the literature contains a few case reports in which barium studies revealed displacement or obstruction of the distal oesophagus, a benign-appearing, smooth, tapered narrowing of the distal oesophagus with a fixed, right-angled configuration is a radiological finding which has not been previously emphasised. In the authors experience, this abnormality may be a helpful radiological clue to the diagnosis of carcinoma of the tail of the pancreas. The clinical, radiological and pathological findings in four patients with dysphagia and a right-angled narrowing of the distal oesophagus secondary to carcinoma of the tail of the pancreas are described and illustrated; the radiological differential diagnosis is briefly discussed.

Diffuse mucosal granularity in double-contrast studies of Crohn's disease of the colon

The radiographic manifestations of idiopathic ulcerative colitis and Crohns disease of the colon have been extensively reviewed and are well known. The increasing use of primary double-contrast barium enemas in patients with inflammatory bowel disease has led to enthusiastic reports concerning the differentiation of ulcerative colitis and Crohns disease. Typically, in ulcerative colitis there is a continuous, diffuse granular mucosal pattern, with or without superadded ulceration; in contrast, Crohns colitis is characterised by discrete ulcers with intervening normal mucosa. In this paper the occurrence of continuous diffuse mucosal granularity in Crohns disease of the colon is described. Four selected cases are used as illustrative examples to emphasise the non-specific nature of this particular finding. Caution must be exercised in attributing specific mucosal patterns to the various forms of infectious and non-infectious colitis.