[Gliomatosis peritonei, an unusual abdominal carcinomatosis: report of two cases]. / La gliomatose péritonéale: un aspect inhabituel de carcinomatose: à propos de deux cas.

We report on 2 cases of ovarian teratoma associated with gliomatosis peritonei in 2 young girls aged 9 and 14 years. Gliomatosis peritonei is an unusual miliary-like peritoneal carcinomatosis of glial tissue. In our experience, follow-up was important to detect abdominal recurrence of glial implants, which had to be removed by iterative surgery. We report a 14-year follow-up and an unusual pleural metastatic disease.

Ileal inflammatory fibroid polyp causing ileocolic intussusception.

Inflammatory Fibroid Polyp (IFP) is an extremely rare tumour involving the gastrointestinal tract (GI) and especially the stomach and small bowel. It presents either as a solitary large or sessile lesion arising from the submucosa and despite a large size and sometimes infiltrating growth, the tumour is always benign and has a good prognosis. Histogenesis remains unknown and controversial. We report an ileal case presenting classically and typically with ileocolic intussusception. Diagnosis was made preoperatively with abdominal mdCT. The polyp itself does not have noteworthy radiological signs but must be included in the large essentially histological differential diagnosis of GI tumours.

Carcinoid tumor of the small intestine: MDCT findings with pathologic correlation.

BACKGROUND: MDCT currently frequently represents the first choice modality for imaging in acute or subacute abdominal conditions implicating the small bowel. As a consequence, the MDCT features of intestinal carcinoid tumors and of their peculiar metastatic spread have to be known by abdominal radiologists. PATIENTS AND METHODS: These features are described and illustrated in the retrospective review of seven proven cases of small intestine carcinoids diagnosed and treated in our institution. The findings are described and correlated with gross anatomy specimens. RESULTS: The primary tumour clearly appeared as a contrast-enhancing intraluminal lesion in all cases except in one case in which the primary lesion remained unlocalized and in another in which the primary tumour finally appeared infracted at gross anatomy. The maximal tumoral enhancement was obtained in 3 patients imaged during the acute arterial phase. The diameter of the primary tumour ranged from 1 to 3 cm and all masses were ileal comprising one lesion in the proximal ileum, two in the medium ileum and three in the distal ileum. 6/7 patients had multiple prominent mesenteric nodal metastases, all also appearing as hypervascularised enhancing masses. In 4/7 patients the nodal metastases represented the major finding being much prominent and larger than the primary tumour. Signs of retractile mesenteritis with soft tissue stranding, retraction and stellate pattern of the mesentery were found around the mesenteric metastases in 5/7 patients and direct incarceration of vessels were found in 3 cases. CONCLUSION: The analysis of the arterial phase of MDCT study appears primordial to detect the sometimes very small but intensively enhancing primary tumor and to delineate encasement or direct obstruction of mesenteric vessels frequently caused by enhancing nodal metastases which volume often exceeds that of the primary tumor. Secondary retractile mesenteritis, deformation or ischemia of bowel loops, and hypervascular hepatic metastases are typical associated findings.

Giant splenic artery aneurysm presenting as unusual cause of obstructive jaundice.

Giant splenic aneurysms larger than 8 cm (GSAA) are rare and often asymptomatic but present an increased risk of dramatic rupture, a life-threatening complication. The management of these aneurysms is especially challenging. We probably report the first case of GSAA revealed by clinical mechanical jaundice due to direct compression of the biliary tree. The lesion was diagnosed during abdominal ultrasound in a 68-year-old patient but determination of the specific splenic origin and extensive anatomic preoperative evaluation were achieved by MDCT. The case illustrates the new high quality performances of MDCT in the evaluation of complex vascular abdominal situations and is presented with a brief review of the relevant literature.

Complicated Meckel's diverticulum diagnosed preoperatively in three cases by complementing CT with detailed us studies.

The clinical and imaging features of Meckel's diverticulum of the adult are reviewed through the report of three complicated cases, one presenting with perforation, the second with intestinal bleeding, and the third with intestinal occlusion due to phytobezoar impaction. Intradiverticular heterotopy of gastric mucosa was the responsible common denominator for the first two cases. Intradiverticular calcified entheroliths were also found in the second case. Obstruction due to a phytobezoar as observed in the third case is a very rare presentation. This report clearly emphasizes and encourages the approach of this difficult diagnosis by combined CT and US imaging.

Gastric ulcer penetrating the anterior abdominal wall: ultrasound diagnosis.

We report two rare cases of penetration of the anterior abdominal wall by gastric peptic ulcers. The full diagnosis was made by ultrasound, which showed similar findings: sharply delineated, hyperechoic craters clearly traversing the gastric wall and covered by hypoechoic inflammatory components of the abdominal wall. Because ultrasound is increasingly used as a primary procedure for evaluation of abdominal complaints, efforts should be directed toward exploring the accessible portions of the gastric and duodenal walls to detect peptic ulcer disease and its complications.

Jejunal diverticulitis: US and CT findings with anatomical correlation.

A rare case of jejunal diverticulitis is described. The jejunal origin of the inflammatory process was suggested by ultrasound and CT but the definite diagnosis was made at surgery with anatomical correlation. The prevalence, physiopathology, symptoms and complications of this rare clinical entity are discussed as well as the uneasy correct diagnosis with imaging techniques. Some diagnostic clues are retrospectively put forward.

Hazards of laparoscopic adrenalectomy for Conn's adenoma. When enthusiasm turns to tragedy.

A 74-year-old man with primary aldosteronism had a small tumor (27 x 23 mm) of his right adrenal gland successfully removed by a transperitoneal laparoscopy. Despite absence of malignancy in the resected tumor and complete relief of all symptoms in the immediate postoperative period, recurrence occurred 6 months later. The tumor behaved as a carcinoma spread in the peritoneal cavity, and the patient eventually died with peritoneal carcinomatosis. We suggest that the laparoscopic technique coupled with pneumoperitoneum may have favored this recurrence.

[Diagnosis of non-hiatal diaphragmatic hernia using helical computed tomography]. / Diagnostic des hernies diaphragmatiques non-hiatales par TDM helicoidale.

The authors report the cases of two patients with non traumatic quiescent diaphragmatic hernias who presented with delayed but classical acute gastrointestinal complications. Their only predisposing factor was previous surgery of the left upper quadrant. The diagnosis, suspected on chest radiographs, was promptly performed by helical CT with multiplanar reconstructions (MPVR) and maximal intensity projections (MIP). The exact nature and relationship of the herniated organs, the precise site and size of the diaphragmatic defects were depicted with a noteworthy effectiveness allowing a prompt surgical treatment. Technical guidelines for helical CT of the diaphragm are purposed and the typical CT signs of diaphragmatic hernias are reviewed. The authors also emphasize the advantages of helical CT over other radiological procedures and confirm it as the actual standard for diagnosis of diaphragmatic diseases.

[Computed tomographic diagnosis of biliary ileus]. / Diagnostic tomodensitometrique de l'ileus biliaire.

Rare in the general population, gallstone ileus accounts for 25 per cent of nonstrangulated small bowel obstructions in patients over the age of 65. While mortality has declined over the years, it remains high at 12-17 per cent. This is largely due to the insidious symptoms making the diagnosis difficult and to the aged patient population, with frequent comorbid medical conditions contributing to mortality. Much better than plain radiograph and probably easier than ultrasound, CT makes the correct diagnosis of the classical triad of Rigler: distended small bowel loops, pneumobilia and an ectopic calcified gallstone. We report two cases promptly and specifically diagnosed with CT. The second case was a very rare Bouveret's Syndrome, a gastric outlet obstruction caused by a gallstone. Patients were treated by a one time associated enterolithotomy and cholecystectomy. We recommend the early use of abdominal CT scanning for the investigation of clinical bowel obstruction in the elderly, where gallstone ileus is a more common condition.

[Presentation of an acute and painful giant, necrotic ileal leiomyoma]. / Présentation aiguë et douloureuse d'un leiomyome iléal géant et nécrotique.

We report on a case of giant necrotic ileal leiomyoma presenting uncommonly as a painful pelvic mass mimicking a sigmoid inflammatory process. The classical symptoms and clinical aspects of intestinal leiomyoma are briefly summarized. The CT and US aspects are described with peculiar attention to color Doppler which played an important role in the diagnosis of our patient.

[A cause of intestinal intussusception in an adult]. / Une cause d'invagination intestinale chez l'adulte.

Inflammatory fibroid polyp is a very rare tumor involving the gastrointestinal tract and especially the stomach and small bowel. It presents either as a solitary pedunculated or sessile lesion arising from the submucosa. Despite its large size and sometimes very infiltrating growth, the polyp is benign and has a good prognosis. The aetiology remains unknown but it probably represents a reactive proliferation similar in many respects to the granuloma pyogenicum. We report an ileal case which presented itself as an acute intussusception. The very typical and complete sonographic and tomodensitometric findings of this intussusception are detailed. The polyp alone does not have noteworthy radiological characteristic signs and must be included in the large and essentially histological differential diagnostic of gastrointestinal tumors.