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PURPOSE: This study evaluated the efficacy of a water-soluble contrast enema (WCE) in predicting anastomotic healing after a low anterior resection (LAR). METHODS: Between January 2000 and March 2012, 682 consecutive patients underwent a LAR or an ultra-low anterior resection (uLAR) and were followed up for leakage. Clinical leakage was established by using physical and laboratory findings. Radiologic leakage was identified by using retrograde WCE imaging. Abnormal radiologic features on WCE were categorized into four types based on morphology: namely, dendritic, horny, saccular, and serpentine. RESULTS: Of the 126 patients who received a concurrent diverting stoma, only two (1.6%) suffered clinical leakage due to pelvic abscess. However, 37 patients (6.7%) in the other group suffered clinical leakage following fecal diversion (P = 0.027). Among the 163 patients who received a fecal diversion, 20 showed radiologic leakage on the first WCE (eight with and 12 without a concurrent diversion); 16 had abnormal features continuously until the final WCE while four patients healed spontaneously. Eleven of the 16 patients (69%), by their surgeon's decision, underwent a stoma restoration based on clinical findings (2/3 dendritic, 3/4 horny, 5/7 saccular, 1/2 serpentine). After stoma reversal, only 2 of the 11 (19%) complained of complications related to the rectal anastomosis. CONCLUSION: WCE is helpful for detecting radiologic leakage before stoma restoration, especially in patients suffering clinical leakage after an uLAR. However, surgeons appear to opt for stoma restoration despite the persistent existence of radiologic leakage in cases with particular features on the WCE.
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Humans , Abscess , Anastomotic Leak , Colorectal Surgery , Enema , Rectal NeoplasmsABSTRACT
Objectives: To know the pelvicalyceal anatomy by radiological method that helps in localizing the calculi or tumors in kidneys. Materials and method: The study was conducted in Sri Devaraj Urs Medical College, Tamaka, Kolar from 2011 to 2013. Forty four adult, formalin embalmed cadaveric kidneys (20 right and 24 left) were injected with 8 to 10 ml of 10% radio opaque barium sulphate solution into the renal pelvis and calyces and radiographs were taken in anteroposterior view. Results: The observations were statistically analyzed. There were 14 extra renal pelves and 30 intra renal pelves. The major calyces were classified into three categories [Double (D), Three (T) and Multiple (M) divisions]. Out of 44 kidneys 20 were right and 24 left.. 23 kidneys presented multiple (more than 4) calyces, 12 had two major calyces and only 9 presented with three major calyces). Typical ‘Y’ arrangement in 03 out of 12 and typical multiple in 03 out of 23 kidneys. There were 14 kidneys (31.8%) presented with extra renal pelvis whereas 30 kidneys (68.2%) presented intrarenal formation of the renal pelvis. Conclusion: Due to the variation in the number of major and minor calyces, position of renal pelvis (intrarenal and extra renal), the knowledge of pelvicalyceal anatomy will help the urologist and nephrologists to pin point the position of renal calyceal calculi or malignant growth for the surgery to be carried out.
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Relata-se o procedimento de mielografia em um ouriço-cacheiro Sphiggurus villosus, adulto, procedente de vida livre. Após o exame e com o animal sob anestesia geral, evidenciou-se um desvio dorsal do contraste na altura da sétima vértebra torácica (T7), causado por compressão em região ventral dessa vértebra, sugestivo de edema ocasionado pela hemorragia intramedular secundária ao trauma sofrido pelo animal em vida livre. Assim sendo, a mielografia em ouriço-cacheiro mostrou ser bastante válida e eficiente ao apresentar como vantagens a maior precisão para delimitar e localizar a lesão presente na coluna vertebral.
The myelography procedure is reported in an adult of the Sphiggurus villosus (hairy-tree-porcupine) species coming from the wild, in the region of Curitiba/PR. After proceeding with the examination, while the animal was under general anesthesia, there was a dorsal deviation of the contrast in the height of the seventh thoracic vertebra (T7) caused by compression in the ventral region of the vertebra. This is suggestive of edema caused by intramedullary hemorrhage secondary to trauma suffered by the animal in the wild. Therefore, the use of myelography in Sphiggurus villosus (hairy-tree-porcupine) proved to be quite valid and efficient, presenting the advantages of greater precision to delimit and locate the lesion present in the vertebral column.
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Objective To summarize clinical imaging characters of the gastric lymphoma in gastroscopy and double contrast radiography of upper gastrointestinal tract.Methods We reviewed 24 cases of gastric lymphoma from January 1996 to June 2006 and analyzed their endoscopic and X-ray features,as well as their pathological results.Results The most frequently involved parts were gastric body(75%,18 cases) and antrum(67%,16 cases).The most common changes were: ①ulcer(71%,17 cases),especially multiple shallow ulcers which had different forms;②nodular protuberance(67%,16 cases),sometimes submucous giant protuberance;③giant duplicature(54%,13 cases);and ④involvement spreading along the gastrointestinal tract(21%,5 cases).Conclusions The characters of gastric lymphoma are ulcer,nodular protuberance,giant duplicature,and so on.The combination use of gastroscopy,radiography,endoscopic mucosal resection,endoscopic ultrasound,and laparoscopy is important for definite diagnosis.
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Objective To evaluate the value of diagnose of colon carcinoma by colonoscopy and double contrast radiography.Methods The results and data of radiography diagnosis,colonscopy diagnosis,biopsy and post-operation pathology were analyzed retrospectively.Results The rate of accordance by X-ray diagnosis was 85.4%,colonscopy 80.5% and biopsy 84.6%.Conclusion The method of examination of colon double contrast radiography preceeds to colonoscopy examination when the patients were suspected suffering from the right colon or left colon carcinoma accompanying by masses;colonoscopy is the first method of diagnosis to choose when the patients were suspected suffering from carcinoma of sigmoid colon or colon polyps undergoing malignant changes.
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Objective To investigate the imaging features of gastrointestinal stromal tumors (GIST) and its diagnostic value. Methods The clinical and imaging data of 41 patients with GIST proved by operation and pathology were analysed. Results Tumors located in the stomach in 20 cases, small bowel in 5 cases, rectum in 3 cases, esophagus in 2 cases and extra gastrointestinal sites in 11 cases. There were 27 malignant GIST diagnosed by imageologic examination,of them, 21 mass exceeded 5 cm in diameter, margins were vague, 19 cases had obvious adhesion or directly involved with around tissue,13 cases with obvious necrosis and cystic changes within the mass. 5 cases with metastase focus.Benign GIST in 14 cases, 11 cases were less than 5 cm in diameter, most of them had smooth margin,homogeneous density and symmetrical enhancement effect.Conclusion X-ray gastrointestinal double contrast radiography examination finds easily inside antrum and inside-and-outside antrum type GIST; CT examination offsets deficiency of general gastrointestinal radiography. It is valuable in localizing precisely, judging benign and malignantin, guiding clinical therapy and estimating prognosis for GIST.
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Objective:To improve the diagnostic accuracy of double contrast radiography of small and micro gastric carcinoma.Methods:The X-ray findings of small gastric carcinoma(9 cases)and micro-gastric carcinoma(3 cases) proved by surgical pathology were analyzed and compared with pathologic finding.1 misdiagnosed cases and 1 missed cases were analyzed.The double contrast films of acute gastric ulcer were reviewed and differentiated with SGC and MGC.Results:8 cases were examined by the double contrast procedure before gastroscopy,4 were diagnosed small gastric carcinoma,1 was diagnosed micro-gastric carcinoma,1 was misdiagnosed ulcer and 1 was missed,1 was suspected of being carcinoma.4 were examined by the double contrast procedure after gastroscopy,2 were small gastric carcinoma and 1 was micro-gastric carcinoma,which accorded with gastroscopy finding.One of micro-gastric carcinoma missed by gastroscopy was detected by DC.Conclusion:The imaging method of double contrast examination is the most effective one in detecting and diagnosing early gastric cancer.The detecting rate should be obviously increased by combining with gastroscopy closely. [