ABSTRACT
The occurrence of small intestinal diverticula is relatively infrequent compared to its counterpart in the large bowel. Duodenal diverticula exhibit a significantly higher prevalence within the small intestine compared to jejunoileal diverticula, with a ratio of five to one. The occurrence of jejunoileal diverticula exhibits considerable variability and has been documented to range from 0.5% to 2.3% in radiographic series, while autopsy studies have reported rates as high as 7%. We present the clinical details of a 65-year-old male patient who sought medical attention due to a constellation of symptoms, including abdominal pain, vomiting, and obstipation. After adequate resuscitation with IV fluids and preoperative preparation, the patient was transported to the operating room for an emergency exploratory laparotomy. Multiple jejunal diverticuli were identified in the proximal jejunum at the antimesenteric border, less than three feet from the duodenojejunal (DJ) junction. The terminal ileum was found to be 360° rotated counterclockwise around the small bowel mesentery, causing the small intestine to appear congested; however, after clockwise de-rotation, the small bowel regained its normal color. Adhesiolysis and small bowel decompression were performed, and the patient had an uneventful recovery.
ABSTRACT
OBJECTIVES: The data on the use of shear wave elastography (SWE) in children with thyroid disorders is limited. We aimed to assess the role of SWE in the evaluation of the thyroid gland in children newly diagnosed with Hashimoto's thyroiditis (HT). METHODS: The thyroid gland was evaluated in 18 children (5 boys and 13 girls, age range: 5-12 years) with newly diagnosed HT and 27 (21 boys and 6 girls, age range: 4-12 years) healthy controls using grayscale ultrasound followed by SWE. The values of SWE (in kPa) were compared between cases and controls and were also correlated with various demographic variables and serum thyroid hormone concentrations. RESULTS: The overall median of SWE values in cases and controls was 20.6 kPa (IQR = 19.16-26.94) and 10.7 kPa (IQR = 9.9-16.32), respectively, and the difference was statistically significant (W = 438.5, P < .001). There was a moderate positive correlation between serum triiodothyronine concentrations and SWE (ρ = 0.57, P = .016) and a moderate negative correlation between serum thyroid stimulating hormone concentrations and SWE (ρ = -0.54, P = .020). A significant difference (W = 61.0, P = .003) was also seen in median SWE of the thyroid gland between boys (median: 29.63 kPa, IQR = 27.53-32.88) and girls (median: 19.43 kPa, IQR = 18.88-21.32). CONCLUSION: There is a significant difference between SWE values of thyroid in normal children and children with newly diagnosed HT. Hence, SWE may be used as a noninvasive imaging technique in distinguishing normal and abnormal thyroid gland at an early stage. We suggest larger studies to confirm our preliminary findings of SWE in pediatric HT.
