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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients who present during pregnancy with acute abdominal symptoms often present a significant diagnostic challenge. Although ultrasound is often the first mode of abdominal imaging, in complex cases further imaging is often necessary. MRI of the small bowel has been made possible with the development of rapid scanning techniques. This has increased the attractiveness of a modality whose benefits include multiplanar imaging, excellent soft tissue contrast and the avoidance of ionizing radiation. With these capabilities MRI has been shown to be a useful adjunct when imaging the small bowel in pregnancy. Although MRI has been employed to investigate small bowel obstruction in the obstetric setting, to date there have been no reports of MR identifying small bowel obstruction secondary to extrinsic compression from a gravid uterus. During pregnancy, small bowel obstruction is most commonly attributed to adhesions. However, there are also antenatal occurrences of small bowel obstruction secondary to uterine compression. We present the MRI findings of an unusual case of small bowel obstruction occurring secondary to compression from a 32-week gravid uterus, in a patient with an end ileostomy. Furthermore, while clinical history and examination are fundamental to diagnosis of intestinal obstruction, the following case highlights the value of MRI in pregnancy as a confirmatory test.
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PMID:The use of MRI to demonstrate small bowel obstruction during pregnancy. 1726 62

Enteropathy associated T-cell lymphoma (EATCL) is a high grade, pleomorphic peripheral T-cell lymphoma with usually cytotoxic phenotype. This is a case report of three patients with EATCL. The first patient was 50 year-old woman with four-year history of gluten sensitive enteropathy (GSE). Diagnosis of lymphoma was confirmed after the resection of the jejunum (small intestine obstruction). Pathohistological (PAS, Reticulin, Giemsa) and immunohistochemical (anti-LCA, anti-CD20, anti-CD45RO, anti-CD3) methods revealed the diagnosis of EATCL: CD45RO+, CD3+. After the third cycle of chemotherapy, the disease progressed with massive lung infiltration. Patient died due to complications of bone marrow aplasia. The second patient was 23 year-old woman with long earlier history of GSE. She presented with the acute renal failure. According to established diagnosis of tubulointerstitial nephritis, she was treated with pulse doses of steroid therapy. After temporary improvement, she had dissemination of the disease. On MRI, small intestinal wall was thickened, and abdominal lymph nodes were enlarged with extraluminal compression of common bile duct. Laparotomy with mesenterial lymph node biopsy and consecutive pathohistological and immunohistochemical analyses revealed the diagnosis of EATCL. The patient received chemotherapy, but she died with signs of pulmonary embolization. The third patient was 53 year-old woman without previous history of GSE. Diagnosis of EATCL was revealed after the resection of jejunum because of small intestinal obstruction. She received two cycles of chemotherapy, but she died with signs of disease progression. IgA antiendomysial antibodies were detected in the serum of all patients. The overall survival of patients was 7 months.The possibility of lymphoma rising in patients with clinical progression of GSE despite gluten free diet must be kept in mind.
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PMID:[Enteropathy associated T-cell lymphoma]. 1750 73

Pelvic actinomycosis is a rare disease that can result in abscess formation, bowel obstruction, and other serious complications. Moreover, the correct diagnosis can seldom be established before radical surgery because the disease often mimics pelvic neoplasms. It has been recently recognized that pelvic actinomycosis is associated with long-term use of an intrauterine contraceptive device.We report a woman with a long-standing intrauterine contraceptive device who visited our hospital complaining of symptoms mimicking large bowel ileus with a subacute course. X-ray fluorography and sigmoidoscopy showed marked stenosis in the sigmoid colon but rejected the possibility of colon cancers. Abdomino-pelvic CT and MRI revealed a huge abscess lying over the urinary bladder and anterior to the uterus. Furthermore, a cervical Papanicolaou smear disclosed Actinomyces species. We removed the intrauterine device from the patient. Subsequent high-dose ampicillin administration led to dramatic shrinkage of the abscess and improved the management of the bowel movement quickly. This is a successful case of symptomatic pelvic actinomycosis that was correctly diagnosed and treated without unnecessary surgical intervention.
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PMID:Pelvic actinomycosis presenting with a large abscess and bowel stenosis with marked response to conservative treatment: a case report. 1803 82

Although often incidentally found, diverticular disease of the small bowel and duodenum may generate complications and impose surgical treatment. Diagnosis of small bowel diverticulosis is difficult because the clinical picture is usually ambiguous. We report a case of diverticulosis of the whole intestine including a giant symptomatic retro-pancreatic duodenal diverticulum in a 74-year-old patient who presented with recurrent episodes of abdominal pain, weight loss and intestinal obstruction. The diagnosis was made by MRI enteroclysis and endoscopy. Open diverticulectomy with choledochostomy and insertion of a T-tube was performed and resulted in a rapid improvement of the symptoms.
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PMID:Open diverticulectomy in a patient with a giant symptomatic retro-pancreatic duodenal diverticulum. A case report. 1929 12

Invasive intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas may be associated with pancreaticogastric fistulas as shown by case reports. We report the case of a benign IPMN associated with pancreaticogastric and pancreaticoduodenal fistulas. A 70-year-old woman was admitted with intestinal obstruction. Computed tomography and MRI showed a large dilatation of the main pancreatic duct (>1 cm) with intraductal nodules, and pancreaticogastric and pancreaticoduodenal fistulas. Several features in imaging were present to support a malignant IPMN, so that the patient underwent a pancreaticoduodenectomy. The histopathological examination of the surgical specimen showed a benign IPMN. This case proves that a benign IPMN can cause pancreaticogastric and pancreaticoduodenal fistulas, probably resulting from mechanical factors.
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PMID:Benign intraductal papillary-mucinous neoplasm of the pancreas associated with spontaneous pancreaticogastric and pancreaticoduodenal fistulas. 2020 11

The challenge of fetal imaging is crucial in France because of the law allowing termination of pregnancy (TOP) until the end of pregnancy. Fetal MRI is an imaging tool always used after ultrasonography (US). Its indications are pertinent only in relation with a prenatal center. Fetal MRI raises parental anxiety to take into account before and during the examination. To date, cerebral indications are predominant. Fetal brain maturation can be followed with MRI (gyration and myelination) but the optimal moment of a fetal MRI depends on the suspected pathology: the analysis of gyration is possible only by 28 WG, as before this time, the brain surface is smooth; in contrast, the posterior fossa demonstrates a definitive morphology since 20 WG. The ventriculomegaly is the most frequent call sign and includes various entities. MRI can disclose associated abnormalities (heterotopia, gyration, white matter, median line), which can suggest diagnosis and pronosis. A cystic pouch of the posterior fossa must lead to a careful analysis of cerebellum and brainstem to approach the diagnosis. Extracerebral indications become progressively larger and fetal MRI is a useful complementary tool after US to study tumors, particularly cervicothoracic masses. MRI can help to assess the level of bowel obstruction but multiple stenosis and post-stenotic bowel is difficult to evaluate. Fetal MRI can help to evaluate bilateral important pyelocalicial dilatation.
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PMID:[Current events in fetal magnetic resonance]. 2082 1

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the established surgical therapy for familial adenomatous polyposis (FAP) and refractory ulcerative colitis (UC). Despite general patient satisfaction with preserved fecal continence, this procedure is associated with a significant long-term morbidity approaching 70% after 10 years, and with a non-negligible rate of pouch failure leading to removal and permanent ileostomy. Following a concise description of the surgical technique, the normal imaging appearance of the ileal "pouch" reservoir at pelvic CT and MRI is explained. Since awareness of their imaging appearances is needed for a correct diagnosis, we discuss and illustrate common and unusual pouch-related complications, including pouchitis and irritable pouch disease; anastomotic leakages and pelvic abscess collections; fistulas involving the ano-perianal region, urinary bladder, vagina, perineal skin, and subcutaneous planes; anal stenosis and small-bowel obstruction. In our experience, pelvic contrast-enhanced MRI has proven invaluable for the diagnostic assessment of patients with suspected pouch-related complications, allowing differentiation of uncomplicated pouchitis from pelvic sepsis, the latter requiring aggressive therapy and possible even in patients with normal endoscopic findings.
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PMID:Ileal pouch and related complications: spectrum of imaging findings with emphasis on MRI. 2129 55

Imaging of pregnant patients with non-obstetric abdominal pain is reviewed, with an accompanying pictorial essay of cases with concentration on magnetic resonance imaging. Non-obstetric causes of abdominal pain during pregnancy are similar to those of non-pregnant patients. The most common causes are appendicitis and cholecystitis. Other causes are myriad and include biliary, gastrointestinal, infectious, inflammatory, and malignant etiologies, among others. The approach to imaging in pregnant patient is unique, as it is imperative to minimize potentially harmful radiation exposures to the fetus. Ultrasound and MRI are the primary modalities for evaluation of the pregnant patient with abdominal pain. The use of intravenous contrast is discouraged, except in highly-selected patients where there is no other way to obtain vital diagnostic information. CT is still used as the mainstay of evaluation of blunt abdominal trauma and is commonly used for diagnosis of small bowel obstruction, stone disease, and work-up of malignancy during pregnancy. A discussion of test selection and underlying rationale is presented.
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PMID:Imaging the pregnant patient with abdominal pain. 2216 Feb 83

BACKGROUND: Recent meta-analysis has demonstrated no significant differences in diagnostic accuracy among different imaging techniques (US, MRI and CT) in the evaluation of Crohn's disease (CD). High-resolution bowel ultrasound has emerged as an alternative imaging technique for the diagnosis and follow-up of patients with CD, being as accurate as CT and MR for detecting intramural and extramural extension of the disease. B-Mode US can evaluate the localization and length of the affected intestinal segments and allow identification of transmural complications, stenosis and intestinal obstruction. Doppler techniques are tools that visualize and quantify bowel vascularization. Contrast-enhanced ultrasound (CEUS) is a new technique that involves IV administration of an ultrasound contrast agent with real-time examination, providing an accurate depiction of the bowel wall microvascularization and the perienteric tissues. The introduction of imaging quantification techniques enables an objective quantitative measurement of the enhancement. METHOD AND RESULTS: The article reviews the technique, sonographic findings, advantages and limitations, and clinical applications of contrast-enhanced US in the evaluation of Cohn's disease. Current CEUS applications in CD are: CD activity assessment, evaluation of inflammatory masses, distinguishing phlegmons from abscesses, characterization of stenosis by differentiating fibrosis from inflammation, monitoring the efficacy of drug treatments and improving the detection of disease recurrence. CONCLUSION: CEUS is an emerging technique that is part of the entire sonographic evaluation, with a role in the diagnosis and follow-up of CD, thus improving therapy planning and monitoring of the efficacy of treatment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-011-0124-1) contains supplementary material, which is available to authorized users.
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PMID:Contrast-enhanced ultrasound (CEUS) in Crohn's disease: technique, image interpretation and clinical applications. 2234 83

We report a case of ileal atresia with meconium peritonitis evaluated by fetal MRI. Prenatal ultrasounds in the third trimester initially demonstrated a cystic abdominal mass that resolved with development of dilated bowel loops. Fetal MRI at 32 weeks gestation identified a perihepatic collection with several dilated small bowel loops and normal sized meconium filled rectosigmoid consistent with distal bowel perforation and loculated meconium peritonitis. Following delivery, the infant presented with bowel obstruction. Contrast enema revealed a normal sized rectosigmoid with small ascending and transverse colon. A distal ileal atresia type IIIa was documented at surgery.
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PMID:Ileal atresia with meconium peritonitis: fetal MRI evaluation. 2247 Jul 14


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