Sat Somers

Retractile mesenteritis of the sigmoid colon

Retractile mesenteritis is a rare disease of unknown aetiology characterised by fibro fatty thickening of the bowel mesentery (Clemett & Tracht, 1969). The disease characteristically involves the small bowel mesentery (Seigel et al, 1980; Sleisenger & Fordtran, 1978; Clemett & Tracht, 1969; Aach et al, 1968). Isolated cases of colonic retractile mesenteritis have been reported (Hartz et al, 1980; Williams & Nelson, 1978). The radiographic features, though characteristic, are not specific; however, in the appropriate clinical context the condition should be considered.

Prospective comparison of small bowel meal with pneumocolon versus ileo-colonoscopy for the diagnosis of ileal Crohn's disease.

BACKGROUND AND AIMS:Both endoscopy and barium radiography are used routinely to diagnose terminal ileal (TI) Crohns disease (CD). A prospective study was undertaken to compare ileoscopy with biopsy to small bowel meal with pneumocolon (SBMP) in patients with suspected TI CD.METHODS:A cohort of outpatients investigated for diarrhea with features of TI disease underwent SBMP followed by colonoscopy with ileal intubation and biopsy within 21 days. All results were reported in a standardized, sequential format to assign SBMP TI diagnoses by the duty radiologist and by dual reading with consensus, ileoscopy by the attending endoscopist, and ileoscopy with biopsy by a blinded panel of endoscopists and pathologists. Reference standard TI diagnoses were determined by a consensus panel with full access to medical records.RESULTS:Among 120 subjects, the reference standard TI diagnosis was normal in 47 (39.1%), lymphoid nodular hyperplasia (LNH) in 24 (20.0%), CD in 48 (40.0%), and NSAID enteropathy in 1 (0.9%). Colonoscopy provided TI images and/or biopsies in 97 cases (80.8%), while SBMP provided TI images in 119 (99.1%). When ileoscopy with biopsy succeeded, its accuracy was similar to SBMP with dual reading (89.7% vs 89.9%, p = NS) but superior to SBMP if interpreted only by the duty radiologist (80.0%, p < 0.05). Biopsy improved the accuracy of ileoscopy, while dual reading improved that of SBMP.CONCLUSIONS:Both ileoscopy with biopsy and SBMP with dual reading are highly accurate for diagnosing TI CD. Choice of initial test should reflect local expertise and availability, and the likelihood of associated disease in the proximal small bowel or colon.

Contemporary Radiological Examination of the Upper Gastrointestinal Tract

Barium and endoscopy both have advantages. Endoscopy not only gives you direct visualization but also the ability to biopsy tissue. It does not give you the ability to determine the exact anatomy or the gross appearance of a lesion. Barium on the other hand gives you a dynamic examination which is particularly useful for the assessment of swallowing disorders and oesophageal motility. When the pharynx and oesophagus are not of prime concern and cost is not a problem then endoscopy is the examination of choice. It has been shown that dyspeptic patients who have had both examinations have a definite preference for endoscopy (Stevenson et al, 1991). As endoscopy requires minimal physical effort, it is also a preferable examination for the unwell patient.

Procedures in gastrointestinal radiology

This book presents several gastrointestinal radiology techniques. Contrast studies are emphasized as well as endoscopic procedures, thus enabling the radiologist to choose the appropriate technology. Each procedure is discussed with reference to materials, patient preparation. positioning, technical factors, and potential problems. Patient-radiologist interaction before, during, and after the results of the study are emphasized.

Magnetic Resonance Imaging of Benign and Malignant Diseases of the Uterus: A Comprehensive Review

Abstract This article describes magnetic resonance imaging features of benign and malignant diseases of the uterus. The benign lesions include leiomyomas, adenomyosis and endometrial polyps, and malignant lesions that include cervical and endometrical cancers. We have discussed (i) the indications for performing magnetic resonance imaging with respect to each clinical situation, (ii) important advantages, (iii) magnetic resonance imaging staging criteria for malignant lesions, and (iv) limitations of this method. We have also listed the crucial differentiating points between (i) focal adenomyosis and leiomyoma, and (ii) recurrent disease and post-treatment fibrosis.

The Role of Magnetic Resonance Imaging in the Evaluation of Congenital Uterine Abnormalities: A Comprehensive Review

Abstract Congenital malformations of the uterus result from non-development or partial or complete non-fusion of the mullerian ducts, and present as a spectrum of reproductive disorders. Magnetic Resonance (MR) Imaging is a valuable technique for non-invasive evaluation of these abnormalities. This article reviews the classification of mullerian duct anomalies, the normal MR anatomy of the uterus, and the MR imaging features of the various congenital uterine malformations. The increasing availability of MR imaging may replace more invasive procedures including laparoscopy and/or hysteroscopy as initial diagnostic procedures.

Upper Gastrointestinal Tract

There is continuing controversy over whether endoscopy or barium meal should be performed for examination of the upper gastrointestinal (GI) tract [1]. For gastroesophageal reflux disease, the barium swallow study is the preferred initial examination and often the only investigation required [2,3]. Barium swallow better detects motor abnormalities [2], but encoscopy is needed for barium-negative dysphagia and for biopsy of strictures [4]. In acute odynophagia or food impaction, endoscopy should be the initial examination (when possible) because barium destroys the endoscopic view and endoscopy often is required in these patients for foreign body removal. Endoscopy can, however, miss tumors of the gastroesophageal junction. If endoscopy is used as the initial esophageal investigation in a patient with dysphagia and this study is negative, a follow-up barium swallow should be performed.

Technical Aspects of Imaging of the Gastrointestinal Tract

Radiological technology is a rapidly growing and changing profession, and dedicated technologists should continually strive to improve their knowledge, understanding, and skills. As health care professionals, they have an important role to play on the radiological team.

Pediatric Gastrointestinal Examinations

Children are not small adults. The signs, symptoms, and disease in pediatric patients often differ considerably from those in adults. A history gathered from parents suggesting a gastrointestinal cause for symptoms may be misleading. The clinician has to evaluate the entire patient and take a complete history to ensure that unnecessary examinations are not performed. It behooves the radiologist to be aware of these problems in diagnosis, and to develop a close rapport with the clinicians to ensure that the patient receives no unnecessary radiation or discomfort in solving a diagnostic dilemma.