Philippe Braude

Magnetic resonance cholangiopancreatography: interest of IV secretin administration in the evaluation of pancreatic ducts

Abstract. The aim of this study was to investigate whether IV secretin administration is useful to enhance the delineation of the main pancreatic duct (MPD) and its side branches, and if it provides additional information concerning signal voids and strictures. Twenty-seven patients referred for abdominal pain or laboratory abnormalities (group 1, n = 13) or for the follow-up of chronic pancreatitis (CP; group 2, n = 14) were studied. Magnetic resonance cholangiopancreatography was acquired at 1.5 T before and after IV secretin by a coronal 3D TSE T2-weighted sequence with maximum intensity projection postprocessing. In group 1 secretin provided a better visualization of MPD in 9 patients. In a patient with pancreas divisum, it allowed suggestion of stenosis of the accessory papilla, confirmed at endoscopic retrograde cholangiopancreatography (ERCP). In group 2 secretin provided a better visualization of MPD only in the 3 patients with mild disease. A mild dilation upstream a stricture occurred in 2 cases and a marked dilation appeared upstream a wallstent which was non-patent at ERCP. Few changes were noticed concerning side branches. These preliminary results indicate that in patients without CP, secretin improves MPD delineation avoiding invasive diagnostic ERCP. In patients with mild CP secretin does not improve the characterization of signal voids, but it may be useful to appreciate their significance and to follow-up stenosis.

Delayed enhancement of the bowel wall: A new CT sign of small bowel strangulation

PURPOSE To report a new CT sign of small bowel strangulation. MATERIALS AND METHODS Two cases of small bowel obstruction evaluated by spiral CT with intravenous contrast injection. RESULTS In both cases we observed an absence of parietal enhancement of the diseased bowel loop, visible on early scans only. This feature was accompanied by signs of bowel obstruction. The two patients had a segment of necrotic ileum resected. CONCLUSION Delayed enhancement of a bowel loop in cases of small bowel obstruction should suggest the diagnosis of strangulation and lead to rapid surgical treatment.

Emergency embolization of a mycotic aneurysm of the superior gluteal artery : case report

The authors report the unusual presentation of a mycotic aneurysm of the superior gluteal artery in a patient with unsuspected bacterial endocarditis. The diagnosis of this atypically large lesion, the therapeutic considerations, and the technical aspects of the endovascular occlusion are discussed.

Endoscopic Cure of a Giant Sacral Meningocele Associated with Marfan's Syndrome

An unusual anterior sacral meningocele associated with Marfans syndrome, with demonstrated dural anomalies related to Marfans syndrome is reported. Endoscopy enabled complete exploration of the meningocele, its morphological description, and ultimate cure. The meningocele resembled an hourglass made up of intrasacral and anterior sacral components. The communication of this bilobed malformation with the dural sac was so small that only the intrathecal injection of a colored solution allowed its localization. The closure of this communication was accomplished under endoscopic view by a single stitch. The postoperative course of the patient was characterized by immediate disappearance of the preoperative clinical signs. Computed tomographic scans demonstrated progressive complete collapse of the anterior sacral meningocele and partial resolution of the intrasacral component. Dural anomalies of Marfans syndrome are described, and their relationship to the formation of the meningocele is discussed.

Case report: Colour Doppler demonstration of pseudoaneurysms complicating pancreatic pseudocysts

The great morbidity and mortality associated with pseudoaneurysms complicating pancreatic pseudocysts stress the need for their early detection. The authors report the use of colour Doppler sonography in the detection of pseudoaneurysms within pancreatic pseudocysts, emphasizing not only the value of this modality in the initial diagnosis, but also its value in monitoring the success of transcatheter embolization. Colour Doppler should be used systematically in the evaluation of pancreatic pseudocysts.

Sonographic evaluation of renal inflammatory diseases in children

SummaryBased on a report of 16 patients, the authors describe and evaluate the sonographic aspects of renal inflammatory diseases (RID) in children. In acute disease, thickening of the renal pelvic wall as evidence of pyelitis was the most common pattern demonstrated. Increased renal volume, nontumoral parenchymal area of hyperechnogenicity, abscess-type mass or calcified solid mass (in the case of xanthogranulomatous pyelonephritis) were other aspects encountered. Related findings included evidence of chronic pyelonephritis (cortical thinning) and of renal malformations. In patients with RID, the role of ultrasound is doubly important. While it is being employed increasingly as a screening test, it is most useful as a follow-up technique to detect complications and assess renal growth. Nevertheless, it should be stressed that ultrasound may be totally normal in cases of RID and complementary examinations (IVP, VCUG and nuclear scanning) are still necessary.

Intussusceptions in Adults: Clinical Course and Associated Lesions

Intussusception in adults is rare. The authors report 18 cases and illustrate the pathological and clinical findings. Intussusception is usually secondary to a benign small bowel lesion or to a malign