CT of blunt splenic injuries: what the trauma team wants to know from the radiologist.

Splenic injury is commonly encountered in severe blunt abdominal trauma. Technological improvements and the increasing availability of both diagnostic computed tomography (CT) and therapeutic splenic artery embolisation (SAE) are key factors in defining the high success rate of modern-day non-operative management (NOM) for blunt splenic injuries (BSIs). The Association for Surgery for Trauma (AAST) Organ Injury Scale (OIS) is commonly used by both radiologists and clinicians to stratify injury severity, traditionally based on the degree of parenchymal disruption seen on CT, and guide management. Its recent 2018 update takes splenic vascular injuries (i.e., active bleed, pseudoaneurysm, and traumatic arteriovenous fistulae) into consideration, the presence of which will indicate at least a grade IV (i.e., high-grade) injury. This is a reflection of the paradigm shift towards spleen conservation with regular use of SAE as the current standard of treatment. Prompted by the latest AAST OIS revision, which represents a more complete and current grading system, we present the spectrum of pertinent CT findings that the diagnostic radiologist should accurately identify and convey to the multidisciplinary trauma team (including the interventional radiologist). This review divides imaging findings based on the AAST OIS definitions and categorises them into (1) parenchymal and (2) vascular injuries. Features that may help in the detection of subtle BSIs are also described. Lastly, it touches on the key changes made to the new AAST OIS, substantiated by case illustrations.

Obesity does not affect sodium picosulphate bowel preparation.

BACKGROUND: A previous study utilising oral polyethylene-glycol by Borg et al. concluded that obesity is an independent predictor of inadequate bowel preparation at colonoscopy. AIM: To compare bowel preparation quality between obese and non-obese individuals as assessed by Boston bowel preparation scale (BBPS) after using sodium picosulphate. METHODS: Prospective recruitment of patients at a day surgical unit in a New South Wales academic hospital. Bowel preparation was with Picoprep in all patients. Body Mass Index and epidemiological details were collected. Bowel preparation efficacy was assessed using the Boston Bowel Preparation Score. RESULTS: One hundred and four patients were enrolled prospectively. Five (4.8%) were excluded owing to poor mental capacity. Sixty-three (64%) were non-obese, and 36 (36%) were obese. Fifty-seven (90%) non-obese and 32 (89%) obese patients had good bowel preparation. There was no statistical difference for sodium picosulphate bowel preparation between obese and non-obese individuals (P > 0.99) using Fisher's exact probability tests. The BBPS score in the left colon predicted the overall BBPS score in all patients (P < 0.001). Three of 99 patients (3%) did not tolerate sodium picosulphate, with nausea being the most common side-effect. LIMITATIONS: Non-randomised study CONCLUSIONS: There was no difference in bowel preparation quality between obese and non-obese patients using a low-volume bowel preparation (sodium picosulphate) and without dose modification of the bowel preparation. Sodium picosulphate was a welltolerated and an effective bowel preparation for obese individuals. With an increasing incidence of obesity and expanding colonoscopic indications within Australia and other Western countries from government-sponsored programs, it is paramount that procedural quality not be compromised in the obese patient.

Emergency gastroduodenal artery embolization by sandwich technique for angiographically obvious and oblivious, endotherapy failed bleeding duodenal ulcers.

AIM: To determine the feasibility, safety, and efficacy of adopting a standardized protocol for emergency transarterial embolization (TAE) of the gastroduodenal artery (GDA) with a uniform sandwich technique in endotherapy-failed bleeding duodenal ulcers (DU). MATERIALS AND METHODS: Between December 2009 and December 2010, 15 patients with endotherapy-failed bleeding DU were underwent embolization. Irrespective of active extravasation, the segment of the GDA supplying the bleeding DU as indicated by endoscopically placed clips was embolized by a uniform sandwich technique with gelfoam between metallic coils. The clinical profile of the patients, re-bleeding, mortality rates, and response time of the intervention radiology team were recorded. The angioembolizations were reviewed for their technical success, clinical success, and complications. Mean duration of follow-up was 266.5 days. RESULTS: Active contrast-medium extravasation was seen in three patients (20%). Early re-bleeding was noted in two patients (13.33%). No patient required surgery. There was 100% technical success, while primary and secondary clinical success rates for TAE were 86.6 and 93.3%, respectively. Focal pancreatitis was the single major procedure-related complication. There was no direct bleeding-DU-related death. The response time of the IR service averaged 150 min (range 60-360 min) with mean value of 170 min. CONCLUSION: Emergency embolization of the GDA using the sandwich technique is a safe and highly effective therapeutic option for bleeding DUs refractory to endotherapy. A prompt response from the IR service can be ensured with an institutional protocol in place for such common medical emergencies.

Gastrointestinal stromal tumors presenting as gynecological masses: usefulness of multidetector computed tomography.

Large extraluminal gastrointestinal tumors (GISTs) may present as pelvic masses and thus mimic gynecological neoplasms in female patients. On clinical examination and pelvic ultrasound, these tumors resemble pedunculated fibroids or ovarian tumors. Multidetector computed tomography (CT), with its ability to perform isotropic multiplanar reconstruction, is useful in differentiating GISTs from true gynecological masses by demonstrating the pedicle sign connecting a pelvic GIST to its organ of origin. This allows a preoperative diagnosis to be made, which may be helpful in guiding therapeutic options and management. We present two cases of GISTs presenting as pelvic masses in which ultrasound findings suggested a gynecological cause, but multidetector CT with multiplanar reconstruction was able to determine their true organ of origin.