Lesions of the Upper Gastrointestinal Tract Identified on Routine Transabdominal Ultrasonography

Recent technical advances and the increasing use of ultrasonography in the evaluation of patients with upper abdominal pain, along with careful attention and effort during ultrasonographic examination, have increased the detection rate of unexpected lesions in the upper gastrointestinal tract. The purpose of this pictorial review is to demonstrate the ultrasonographic findings of various lesions involving the stomach and duodenum, detected during routine transabdominal ultrasonography without ingestion of water. In the study, the ultrasonographic findings are correlated with comparative studies of gastroscopy, CT, endoscopic ultrasonography, and barium studies of the upper gastrointestinal tract.

Sonography-guided Gastrografin Enema for Meconium Plug Syndrome in Premature Newborns: Preliminary Results

PURPOSE: To evaluate the usefulness of sonography-guided Gastrografin enema for the diagnosis and treatment of meconium plug syndrome in premature newborns in a neonatal intensive care unit (NICU). MATERIALS AND METHODS: Fifteen premature newborns underwent 23 sonography-guided Gastrografin enemas on the 8th day of life on average (range: 3 days-21 days). The gestational age and birth weight (mean+/-standard deviation) of the patients were 29+/-2 weeks and 999+/-148 g, respectively. The diagnosis of meconium plug syndrome was based on relevant clinical and radiological findings. Diluted Gastrografin (1:3, 17-45 ml) was administered through a rectal tube under the guidance of sonography until it reached to the cecum. Thereafter, immediate post-procedure and delayed portable abdominal radiographs were taken. All the procedures were done within the NICU. We reviewed the dates of meconium evacuation and the first feeding after the last enema from the clinical data. Radiologically, the timing of the radiographic improvement after the last enema was checked. In cases of distended distal ileum with meconium on pre-enema sonography, follow-up sonography was performed to determine the interval change after gastrografin enema. RESULTS: None of the sonography-guided Gastrografin enemas performed within the NICU caused procedure-related complications. Meconium was evacuated within one day in all patients. In 14 patients, on average, feeding was started on the 7th day and radiographic improvement was observed on the 3rd day. Four of the five patients showing a distended distal ileum with meconium revealed a decrease in ileal distension on follow-up sonography. On the other hand, the other patient, who did not show such a decrease on follow-up sonography, was found to have ileal stenosis during subsequent surgery. CONCLUSION: Sonography-guided Gastrografin enema is a safe and effective bedside procedure, when performed in the NICU for the diagnosis and treatment of meconium plug syndrome.

Phlegmonous Enteritis in a Patient with Congestive Heart Failure and Colon Cancer

Phlegmonous enteritis is a rare infective inflammatory disease of the intestine, predominantly involving the submucosal layer. It is difficult to diagnose and often fatal. Its association with alcoholism and various liver diseases, although rarely reported, is well documented. We report a case of phlegmonous enteritis in a male patient with congestive heart failure and colon cancer, and describe the ultrasonographic and CT findings.

The Tender Masses in Right Lower Abdomen: Ultrasonographic and CT Features

Perforated appendicitis with an abscess formation is known to be the most common cause of tender mass in right lower abdomen. The differential diagnosis of a tender mass in right lower abdomen, however, is broad and includesvarious intraabdominal and intrapelvic lesions in origin. Preoperative accurate diagnosis is essential in order toavoid unnecessary surgery or complications resulting from delayed surgery. The purpose of this pictorial essay isto illustrate examples of various causes and methods to differentiate them with ultrasonography and CT.