Intraoperative translabial ultrasound for urethral diverticula: a road map for surgeons.

PURPOSE: To highlight the importance of intraoperative translabial ultrasound, for identification of diverticular neck allowing complete resection of periurethral diverticula and decrease in the recurrence rate. MATERIAL AND METHODS: This study included 4 women of age range between 38 and 68 years presenting for recurrent urinary tract infections and urethral pain. All had translabial urethral ultrasound and cystoscopy with and without U/C guidance. RESULTS: Prior cystoscopy in all these patients failed to demonstrate the diverticulum. Translabial ultrasound showed the diverticula some of which were infected. Ultrasound was used intraoperatively to guide the surgeon. With this approach the abnormality was confirmed and the neck of the diverticulum was identified through percutaneous needle insertion. This allowed complete resection of the diverticula. CONCLUSION: Translabial ultrasound is a non-invasive technique that plays a major role in examining the urethra and identifying the periuthral diverticula. In our experience, it was very useful as an adjunct to guide the surgeon intraoperatively allowing complete excision of the diverticulum.

Unilocular hepatic echinococcal cysts: sonography and computed tomography findings.

AIM: In endemic regions, unilocular hepatic echinococcal cysts (HEC) may be difficult to differentiate radiologically from simple non-parasitic cysts, especially if serological tests were negative. The aim of this descriptive study is to elucidate distinctive imaging findings that allow a diagnosis of HEC. MATERIALS AND METHODS: The sonographic and computed tomography (CT) findings of 21 patients with proven unilocular HEC were retrospectively analysed. A total of 28 examinations were reviewed, including 14 sonograms (ultrasound; US) of the liver and 14 CT studies. RESULTS: Seven imaging features that help in the diagnosis of unilocular HEC were identified by US and/or CT in 14 patients (14/21; 66.6%). They are, by order of frequency: hydatid sand (29.2%), focal or segmental thickening of the cyst wall (29.2%), coexistent echinococcal cysts in the spleen or lungs (16.6%), pericystic biliary radicles dilatation (8.3%), atrophy of the right lobe with compensatory hypertrophy of the left hepatic lobe (8.3%), satellite cysts typical of HEC in the liver (4.2%) and pericyst calcification (4.2%). CONCLUSION: These ancillary signs should prompt us to consider HEC as the cause of a unilocular cyst in approximately two-thirds of patients.

Improved US visualization of the pancreatic tail with simethicone, water, and patient rotation.

PURPOSE: To evaluate the effect of degassed water, simethicone, and patient rotation on ultrasonographic (US) visualization of the pancreatic tail. MATERIALS AND METHODS: Seventy patients in whom visualization of the pancreatic tail was poor at US were reevaluated in the upright position after ingesting 2 cups (500 mL) of water with 80 mg of simethicone followed by rotating three times on the examination table. In a few patients, the right posterior oblique position was used. Pancreatic tail visualization and disbursement of gastric gas were evaluated. Seventy patients who received 500 mL of distilled water only served as control subjects. RESULTS: Pancreatic tail visualization in patients versus control subjects was complete in 55 (79%) versus five (7%) of 70 patients and control subjects, partial in 10 (14%) versus 38 (54%), and not improved in five (7%) versus 27 (39%). The effect on diminishing gastric air was closely correlated with the degree of improved visualization in most patients. All patients tolerated the procedure well, with no side effects. The technique added a mean of 8 versus 5 minutes to the examination in patients versus control subjects. The full acoustic window effect of the simethicone-water mixture lasted approximately 10 minutes. CONCLUSION: The simethicone-water-rotation technique is simple, safe, inexpensive, and effective for improving pancreatic tail visualization in ambulatory patients and is superior to the use of water alone.

Abdominal cocoon in a man: preoperative diagnosis and literature review.

Sclerosing encapsulating peritonitis, or abdominal cocoon, is a relatively rare cause of intestinal obstruction, described mostly in young adolescent girls. It is characterized by a thick fibrotic peritoneum that wraps the bowel in a concertinalike fashion with some adhesions. Because of its peculiar characteristics, this condition presents many difficulties in preoperative diagnosis. Recognition of the entity results in proper management and prevents unnecessary bowel resection. We report a man with intermittent intestinal obstruction and an abdominal cocoon encasing the small bowel that was diagnosed preoperatively by radiology. To the best of our knowledge, this represents the fourth male patient reported in the medical literature to develop this condition. We briefly review the literature and discuss the preoperative diagnosis and management of sclerosing encapsulating peritonitis.