Hourglass Bladder Deformity Induced by Chronic Ketamine Abuse.

Regular and chronic use of ketamine causes inflammatory changes in the urinary tract. Imaging has a crucial role in the assessment of this pathology. A particular imaging characteristic of an hourglass-shaped bladder is highlighted in three cases of ketamine intoxication. Teaching point: Three cases of ketamine intoxication with a characteristic bladder deformation are reported.

The second case of a young man with L-arginine-induced acute pancreatitis.

BACKGROUND: Dietary supplementation of arginine has been used by numerous world-class athletes and professional bodybuilders over the past 30 years. L-Arginine indeed enhances muscular power and general performance via maintaining ATP level. However, L-arginine is also known to induce acute pancreatitis in murine models. CASE REPORT: We report the case of young man presenting with upper abdominal pain and increased serum lipase levels. Contrast-enhanced computed tomography confirms a mild acute pancreatitis. Common etiologies have been ruled out and toxicological anamnestic screening reveals the intake of protein powder. This is, to the best of our knowledge, the second case in human of arginine-induced acute pancreatitis. CONCLUSION: This case report suggests that every patient presenting with acute pancreatitis without obvious etiology should be evaluated for the intake of toxics other than alcohol, including L-arginine.

Pneumoscrotum, pneumomediastinum, pneumothorax, and pneumorrhachis following colon surgery.

We report the case of an 80-year-old man who developed a colocutaneous fistula as a complication of anastomotic leakage following segmental colonic resection. The patient presented with an abscess of the abdominal wall, subcutaneous emphysema, pneumomediastinum, pneumothorax, pneumorrhachis, and pneumoscrotum. We discuss the possible mechanisms for these unusual clinical presentations of extraperitoneal air following anastomotic leak.

Accuracy of MDCT in predicting site of gastrointestinal tract perforation.

OBJECTIVE: The purpose of this study was to prospectively evaluate the accuracy of MDCT for preoperative determination of the site of surgically proven gastrointestinal tract perforations and to determine the most predictive findings in this diagnosis. SUBJECTS AND METHODS: We prospectively studied 85 consecutive patients with extraluminal air on MDCT who had surgically proven gastrointestinal tract perforations. All patients underwent surgery within 12 hours after MDCT was performed. Two experienced radiologists, blinded to the surgical diagnosis, reached a consensus prediction of the site of the perforation using the following eight MDCT findings: concentration of extraluminal air bubbles adjacent to the bowel wall, free air in supramesocolic or inframesocolic compartments, extraluminal air in both abdomen and pelvis, focal defect in the bowel wall, segmental bowel-wall thickening, perivisceral fat stranding, abscess, and extraluminal fluid. MDCT imaging results were compared with surgical and pathologic findings. Logistic regression analyses were performed to assess the significance of the different radiologic criteria. RESULTS: Analysis of MDCT images was predictive of the site of gastrointestinal tract perforation in 73 (86%) of 85 patients. Logistic regression showed that concentration of extraluminal air bubbles (p < 0.001), segmental bowel wall thickening (p < 0.001), and focal defect of the bowel wall (p = 0.007) were strong predictors of the site of bowel perforation. CONCLUSION: MDCT is highly accurate for predicting the site of gastrointestinal tract perforations. Three of eight CT findings significantly correlate with surgical diagnosis.

Intragastric band erosion after laparoscopic adjustable gastric banding for morbid obesity: imaging characteristics of an underreported complication.

OBJECTIVE: Our purpose was to describe the imaging findings of intragastric band erosion, an underreported complication after laparoscopic adjustable gastric banding for the treatment of morbid obesity. In this long-term complication, the gastric band fastened around the upper stomach to create a small proximal gastric pouch gradually erodes into the stomach wall and can extend into the gastric lumen. We present three cases of patients with band erosion in whom findings on an upper gastrointestinal series and CT established the diagnosis. CONCLUSION: Diagnosis of intragastric band erosion after gastric banding is usually made with endoscopy. However, the radiologic appearance of band erosion when visualized on an upper gastrointestinal series is pathognomonic and allows initial imaging diagnosis. In patients with extraluminal air or prosthesis infection, CT findings also are suggestive of this postoperative complication.