Reed P. Rice

Surgical management of intestinal obstruction in ovarian cancer: I. Clinical features, postoperative complications, and survival

The results of surgery to relieve intestinal obstruction in 49 patients who were known to have ovarian cancer were studied. All patients had received adjunctive chemotherapy and/or radiation therapy prior to bowel obstruction. Thirty patients had small bowel obstruction, 16 patients had colonic obstruction, and 3 patients had concurrent small and large bowel obstruction. Clinical status, nutritional parameters, and radiographic findings were analyzed. Progressive ovarian cancer was ultimately found to be the cause of obstruction in 86% of patients. Major postoperative complications occurred in 49% of patients and were encountered significantly more frequently in those patients with small bowel obstruction (P less than 0.04). Complications most frequently encountered included wound infection, enterocutaneous fistulae, and other septic sequelae. Median postoperative survival was 140 days, with 73% surviving at 60 days postoperatively. A total of 14.3% of patients were alive 12 months postoperatively. These results are similar to prior reports and emphasize the need for clearer preoperative selection criteria.

Esophageal Intramural Diverticulosis

Abstract This paper presents 3 patients with esophageal intramural diverticulosis and discusses the roentgenographic, manometric, histological, and microbiological picture attendant to this disease. Evidence is given to support chronic infection of esophageal submucosal glands as the predominant cause.

Synchronous and Metachronous Squamous Cell Carcinomas of the Head, Neck and Esophagus

Thirty-four (1%) of 3,287 patients with squamous carcinoma of the head-neck developed carcinoma of the esophagus. The clinical and radiological importance of this relationship is emphasized. Since there is an increased incidence of esophageal carcinoma in this group, perhaps all such patients should have an annual esophagogram.

The spectrum of small bowel melanoma.

Twenty-one patients with documented secondary small bowel involvement by malignant melanoma are reviewed. Roentgen mainfestations are discussed and illustrated. A vigorous diagnostic approach emphasizing enteroclysis is described. Clinical awareness and aggressive radiologic investigation are providing these patients with earlier surgical and adjuvant therapy, which appears to be leading to increased length of survival.

Abdominal radiography in the emergency department: A prospective analysis

We present a prospective analysis of 100 consecutive abdominal radiographs of 96 emergency patients who were referred to radiology with a variety of abdominal complaints. In patients with diffuse, nonspecific abdominal pain, nausea, vomiting, or gastrointestinal bleeding, 98% of the radiographs were negative or had positive findings which were unrelated to the current clinical problem. Ninety-three percent of the positive radiographs that were related to the acute problem occurred in patients with renal colic; hematuria; ingestion of foreign bodies; previously known surgical conditions, such as incarcerated hernias; intra-abdominal metastatic carcinoma; fecal impaction; or true acute abdominal syndromes.

Computed tomography of pneumatosis intestinalis

Four cases of pneumatosis intestinalis detected by computed to mography (CT) are described. Plain abdominal films obtained on the same day as CT failed to show pneumatosis in three of the four cases. The CT appearances characteristic of pneumatosis intestinalis are cystic, linear, or curvilinear gas collections in the periphery of distended, partly fluid-filled loops of bowel. Two of the four cases had underlying bowel infarction. Evidence of pneumatosis should be carefully looked for in patients with acute abdominal pain referred for CT examination. Computed tomography may be a useful modality for the early diagnosis of bowel ischemia when plain abdominal films are non-contributory.

Gastrointestinal complications of renal transplantation

G ASTROINTESTINAL complications occur with distressing frequency in patients who have undergone renal transplantation. Virtually every segment of the gastrointestinal tract can be a site of complication. The more serious of these complications, such as bowel perforation, bowel necrosis, and hemorrhage, are common causes of death in patients who have undergone successful renal transplantation ~3,12,13.16.17,21),25.29,3~~

Computed Tomography in the Diagnosis of Intra-abdominal Abscesses

The diagnosis of intra-abdominal abscess by radiographic means often relies on combining the results of several different imaging modalities. Computed tomography (CT) has been shown to be a safe, accurate and rapid diagnostic method of diagnosing these abscesses. Five patients with a variety of intra-abdominal abscesses are presented in whom the CT scan alone provided the correct diagnosis. The various imaging modalities available for the radiologic diagnosis of intra-abdominal abscess are described and are compared to CT diagnosis regarding their pitfalls.

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

Papers Presented at the Eleventh Annual Session of the Society of Gastrointestinal Radiologists, October 1, 1981, Boca Raton, Florida ESOPHAGEAL NODULARITY A NORMAL VARIANT OF THE ESOPHAGEAL MUCOSA Seth N. Glick, M.D. Steven K. Teplick, M.D. Department of Diagnostic Radiology Hahnemann Medical College and Hospital 230 North Broad Street Philadelphia, PA. 19102 Small superficial round nodules (2-4 mm) are frequently observed on routine double contrast esophagrams. They may be focal or diffuse, and appear as fine granularity or sharply defined filling defects. Endoscopic~lly, they are seen as white excrescences on a normal mucosal background. However, they may not be appreciated, unless specifically sought, becaUse of inadequate lumenal distension. Biopsy reveals normal or slightly hyperplastic squamous epithelium and vacuolated epithelial cells containing abundant glycogen. This has been termed glycogenic acanthosis. Esophageal symptoms are usually absent or cannot be correlated with this morphology. We evaluated 300 consecutive esophagrams considered to demonstrate adequate mucosal detail. Nodularity was found in 30%. These were usually confirmed endoscopically when sought. In addition to true nodules, pseudo-nodules may be caused by several types of artifacts such as transverse esophageal folds. Several pathologicconditions may resemble the normal esophageal nodules, however, radiologic and clinical criteria can usually make the distinction. The Esophageal Survey in Upper Gastrointestinal Radiography Dean D. T. Maglinte, M.D., Katharine L. Krol, M.D., Lloyd D. Caudill, M.D., David L. Brown, M.D., and William Michael McCune, M.D. Gastrointestinal Radiology Section Methodist Hospital and Graduate Medical Center, 1604 North Capitol Ave., Indianapolis, IN 46206 When an upper gastrointestinal study is requested on a patient with non-specific abdominal complaints, there are no guidelines as to what should be the minimum esophageal survey. Of 200 patients referred for upper gastrointestinal series, 40 (20%) had radiographic evidence of esophageal disease. Reflux esophagitis, frequently considered difficult to diagnose radiographically, was demonstrated in 31 (16%). A non-invasive carcinoma, varices and a leiomyoma were found. It is suggested that a thorough evaluation of the esophagus consisting of double contrast, single contrast distention radiograph, fluoroscopic motility assessment and mucosal relief study be included in every upper gastrointestinal series. This minimum multiphasic routine evaluation offers the potential for improvement in diagnostic accuracy with little additional examination time. Barium Swallow After Total Laryngectomy Koehler RE, Balfe DM, Setzen M, Weyman P J, Baron RL, Ogura J Department of Radiology and Divls]on of Otolaryngology, Washington University School of Medicine, St. Louis, Mo Dysphagia is a frequent problem in patients who have undergone total laryngectomy and the barium swallow is often useful for evaluaHng the cause for the symptoms. The examination may be di f f icul t to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor or the operation itself. We analyzed radiographs and clinical information on 43 patients with total laryngectomy with followup periods ranging from g months to 17 years. Recurrent tumor was found in IS patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in nine patients apeared either as a long symmetrical r~arrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 12 patients and presaged the development of recurrent tumor in five. Cricopharyngeal muscular-dysfunctlon accounted for the dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium swallow and the radiographic findings often indicate the correct diagnosis with a high degree of confidence. 0364-2356/82/0007-0087

Extraperitoneal Gas Following Nephrectomy: Patterns and Duration

01.80 9 1982 Springer-Verlag New York Inc.