A rare case of early onset type of abdominal trocar site hernia (TSH) with atypical externalizing in two-step: multidetector row CT diagnosis.

We report a rare case of early onset type Trocar Site Hernia (TSH) producing in the right lower abdominal quadrant of a 64-year old obese woman. The patient was admitted in the emergency room for abdominal pain producing four days after laparoscopic adnexectomy. The hernia atypically externalized in two-steps creating two superposed concentric small bowel strangulating hernias producing through two distinctive superposed orifices. A precise and complete anatomic diagnosis was made by contrast enhanced 64-row multidetector computed tomography (MDCT). The imaging features are presented with a short review of the literature. The case emphasizes the high performances of MDCT for the early diagnosis of Trocar Site Hernias.

Mass-forming intrahepatic cholangiocarcinoma presenting with painful obstructive hemobilia.

We report a very rare case of acute obstructive hemobilia caused by bleeding of a mass-forming intrahepatic cholangiocarcinoma in a 75-year old man. The prompt complete emergency diagnosis was made by ultrasound and confirmed by MDCT. The features of hemobilia and intrahepatic cholangiocarcinoma are briefly reviewed.

Extensive propagation of a pancreatic pseudocyst along the lower limb through the sciatic foramen.

The extremely rare extensive propagation of a giant retroperitoneal pancreatic pseudocyst into the posterior compartment of the lower limb as far as the knee is reported. The extension was found producing through the sciatic foramen and the full diagnosis was made by MDCT. A complete healing was progressively obtained in the 78-year old female after a six months period of sequential multidisciplinary therapeutic approach comprising combined medical and surgical intra-abdominal and external drainage.

Small bowel obstruction due to an internal herniation through a defect of the broad ligament.

We report on a case of internal hernia through a defect of the broad ligament of the uterus. Early diagnostic may be possible with multidetector CT and lead to early treatment. MDCT can help achieving early preoperative diagnostic and allows early laparoscopic treatment with prompt recovery.

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.

Intraabdominal counter clockwise gastric volvulus incarcerated through a defect of the lesser omentum: CT diagnosis.

We report the probably first case of incarcerated intra-abdominal gastric volvulus protruding through a defect of the pars flaccida of the lesser omentum. The 79-year-old woman presented with acute symptoms of upper gastrointestinal occlusion. Plain film radiographs, endoscopy and attempts at opacifying the upper alimentary tract failed to make the correct diagnosis. The definite preoperative diagnosis was achieved by mdCT thanks to high quality multiplanar reconstruction (MPR). In the reported case coronal oblique MPR views and vascular volume rendering views (VR) were of particular interest for the preoperative diagnosis.

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.

Emphysematous epididymitis as presentation of unusual seminal vesicle fistula secondary to sigmoid diverticulitis: case report.

This case report describes a sigmoid diverticulitis with torpid development, long-term symptoms of bladder irritability, and an emphysematous epididymitis caused by a direct seminal vesicle fistula. The diagnosis was suggested by scrotal ultrasound visualizing gas in the scrotum; the complex pelvic fistulous tract was specifically delineated by multislice computed tomography. This may be the first reported case of seminal vesicle fistula directly related to colonic diverticulitis and causing emphysematous epididymitis.

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.

US and CT diagnosis of a twisted lipomatous appendage of the falciform ligament.

Pathologic conditions of the falciform ligament leading to surgical intervention are extremely uncommon. We report a case of twisted lipomatous appendage of this ligament, demonstrated by US and CT. To our knowledge, there have been no previous reports of this entity. The extraperitoneal nature of the lesion was found by realtime sonography, but CT only was able to characterize its lipomatous nature and relationship with the falciform ligament. This lesion should be considered in the differential diagnosis of intra-abdominal focal fat infarction (IFFI), a recent vocable essentially regrouping infarction of omentum and epiploic appendages.

[Diagnosis using spiral computed tomography of an internal hernia through the uterine broad ligament]. / Diagnostic par scanner spirale d'une hernie interne au travers du ligament large uterin.

Internal hernia is an uncommon cause of intestinal obstruction producing only 1% of all acute small bowel obstructions. Hernias involving a defect of the broad ligament of the uterus are particularly uncommon. We report a case successfully diagnosed by spiral CT with multiaxial reconstruction.

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.

[Strangulated intestinal Spigelian hernia]. / Strangulated intestinal Spigelian hernia.

Spigelian hernia, an uncommon hernia of the anterior abdominal wall, has serious complications in a high percentage of cases. The diagnosis is often difficult because the symptoms can be insidious or simulate those of more classical lower quadrant abdominal diseases. Furthermore, the clinical findings are often nonspecific. We report a case of Spigelian hernia complicated by acute strangulation diagnosed by ultrasound. The anatomic features and the physiopathology are reviewed and illustrated by another typical case diagnosed by CT. CT is superior to sonography in showing the defect of the abdominal wall, in identifying the contents of the hernial sac and in discovering abnormalities in other areas of the abdomen. Sonography also generally appears adequate in showing a parietal defect. We therefore recommend systematic ultrasonographic examination of the abdominal wall in all doubtful cases of undiagnosed abdominal pain with vague gastro-intestinal symptoms.

Expression and inheritance of RSVLTR-rtGH1 complementary DNA in the transgenic common carp, Cyprinus carpio.

Transgenic common carp, Cyprinus carpio, possessing the long terminal repeat (LTR) sequence of avian Rous sarcoma virus (RSV) fused to the rainbow trout (rt) growth hormone (GH1) complementary DNA (cDNA) were produced by microinjection. Initial studies showed that the transgenic common carp transmitted the foreign DNA to a significant fraction of their progeny in three of four crosses of transgenic males with control females. These progeny grew 20 to 40% faster than their nontransgenic full siblings. In this study, additional experiments were conducted to evaluate inheritance and expression of the foreign GH gene in transgenic common carp, and the growth performance of these transgenic fish. Four P1 (parental generation produced by microinjection) x nontransgenic controls, four P1 x P1, and one P1 x F1 matings of transgenic carp containing RSVLTR-rtGH1 cDNA were made. The percentages of transgenic progeny resulting from these matings were: 0, 32, 42, 100 (4 progeny only), 21, 21, 31, 30, and 23%, respectively. All crosses except 1 siblot (control x P1) exhibited progeny ratios below the expected 50 or 75% transgenic. These results indicate that most of these transgenic P1 had the foreign gene in their germ line but were mosaics, and at least one transgenic individual did not have the RSVLTR-rtGH1 cDNA in the gonadal tissue. Both P1 and F1 transgenic fish produce trout growth hormone mRNA and polypeptide as determined by reverse transcription polymerase chain reaction amplification, RNA dot-blot hybridization, and radio-immunobinding assay. Growth response by families of F1 transgenic fish to the addition of rtGH1 cDNA varied widely.(ABSTRACT TRUNCATED AT 250 WORDS)

Transfer, expression, and inheritance of salmonid growth hormone genes in channel catfish, Ictalurus punctatus, and effects on performance traits.

We examined expression and inheritance of salmonid growth hormone genes RSVLTR-rtGH1 cDNA and RSVLTR-csGH cDNA, transferred to channel catfish (Ictalurus punctatus) by microinjection. One to 9 copies of the foreign DNA were inserted in either head-to-tail tandem array at single insertion sites or single copies at multiple insertion sites. All P1 transgenic catfish evaluated produced salmonid growth hormone regardless of the construct. Five P1 x P1 matings were accomplished. The spawning rate and fertility of these P1 transgenics in artificial spawning conditions were comparable to those of normal channel catfish. In two of three years, 100% spawning and 100% hatch were obtained. Percent transgenic progeny observed in the five matings were 20, 52, 7, 47, and 0%, which was lower (P < 0.001, chi 2) than the 75% inheritance expected assuming the P1 brood stock had at least one copy of the foreign gene integrated and were not mosaics in the germ line. At least 7 of 10 P1 were mosaics, and a minimum of 2 of 10 P1 did not possess the salmonid growth hormone genes in their germ line. P1 transgenics grew at the same rate as their nontransgenic full siblings, which is not surprising because the P1 were mosaics. F1 transgenic progeny in two families possessing RSVLTR-csGH cDNA grew 26% faster, to 40 to 50 gm, than their nontransgenic full siblings when evaluated communally. One F1 progeny group produced by RSVLTR-rtGH1 cDNA x RSVLTR-csGH cDNA mating and one F1 progeny group (parents either RSVLTR-rtGH1 cDNA or RSVLTR-csGH cDNA) grew at the same rate as normal full siblings when grown communally to 25 gm and 60 mg, respectively. In families where F1 progeny grew faster than controls, the range in body weight and coefficient of variation for the transgenic full siblings were less than those for controls. In families where F1 progeny grew at the same rate as controls, range in body weight and coefficient of variation were similar for transgenic and normal individuals. The percent deformities observed in P1 transgenics (13.6%) was higher (P < 0.05) than in microinjected P1 nontransgenics (5.1%). Percent deformities in transgenics and control F1 channel catfish was not different (p > 0.05; 0.5 and 2.8%, respectively).