Appendicitis and diverticulitis of the colon: misleading forms.

Appendicitis and diverticulitis of the colon are the two main causes of febrile acute abdomen in adults. Diagnosis from imaging (ultrasound and CT) is usually easy. However, an imaging procedure which is not suitable for the clinical situation and an examination performed with the wrong protocol are sources of error and must be avoided. Anatomical variants, inflammatory cancers, complicated forms (perforation, secondary occlusion of the small intestine, peripheral abscesses, fistulae, pylephlebitis, liver abscesses) and associated signs related to a peritoneal inflammatory reaction (reflex ileus, reactive ileitis or salpingitis) can also lead to a wrong diagnosis.

Bouveret's syndrome. An unusual localization of gallstone ileus.

This case report describes a 77-year-old male, who presented to the emergency room with symptoms of an acute proximal small bowel obstruction. Abdominal CT scan with multi-planar reconstructions led to the diagnosis of an intestinal obstruction due to impaction of a large gallstone in the second portion of the duodenum. The CT scan demonstrated a large cholecysto-duodenal fistula as the origin of the gallstone migration. Surgical treatment consisted of milking the stone down beyond the ligament of Treitz, where it was removed through a jejunal enterotomy. The postoperative course was uncomplicated. No attempt was made to repair the choledocho-duodenal fistula at the initial intervention nor subsequently, and there have been no complications due to the fistula over 36 months of follow-up observation.

Diagnosis of colonic volvulus: findings on multidetector CT with three-dimensional reconstructions.

Large bowel volvulus is a rare condition that can occur in patients who present with acute abdominal pain. Radiologists should be able to recognise its appearance on multidetector CT (MDCT) images so that the correct diagnosis can be made and catastrophic consequences can be avoided. In this article, we discuss and illustrate the MDCT and three-dimensional appearance of the various forms of large bowel volvulus. As MDCT allows the precise diagnosis of topography, mechanism and severity, this technique can provide an accurate assessment of large bowel volvulus.

[Appendiceal mucoceles, pseudomyxoma peritonei and appendiceal mucinous neoplasms: update on the contribution of imaging to choice of surgical approach]. / Mucocèles appendiculaires, pseudomyxomes péritonéaux et tumeurs mucosécrétantes du carrefour iléocaecal: apport de l'imagerie dans la stratégie thérapeutique et le choix de la voie d'abord laparoscopique ou classique.

INTRODUCTION: The treatment of pseudomyxoma peritonei (PMPs) and appendiceal mucocele (AM) has changed radically. To assess the contribution of preoperative imaging to the treatment strategy and choice of approach, a surgeon and a radiologist different from the initial radiologist examined the files of all patients treated for PMP or AM in four facilities in one district from January 1, 1996, through December 31, 2008. PATIENTS AND METHODS: The study included 27 patients (20 men and seven women, mean age: 63+/-13 years). Eleven patients had an intact AM, seven synchronous PMP (malignant appendiceal lesion in two of seven), six metachronous PMP (five with peritoneal mucinous carcinomatosis and one with diffuse peritoneal adenomucinosis) and three a ruptured AM but not PMP. The incidence of mucin-secreting tumors observed (27 cases in 12 years in a region of 500 000 inhabitants) corresponds to a prevalence of approximately five cases per year per million inhabitants. Acute clinical pictures (7/27) were significantly more frequent for the malignant forms (5/7) (p<0,02). RESULTS AND DISCUSSION: The overall sensitivity of computed tomography (CT) for all the criteria studied was 93%. The predictive value for AM rupture of visualization of thick calcifications was 100%. On the other hand, rupture never occurred when the CT showed an AM under pressure, with thin walls and septa. The predictive value for PMP of "scalloping" was 100%. The diagnostic accuracy of the initial reading was 25/27 for the imaging overall and 25/25 for the CT. Preoperative visualization of the exact size of the intact AM or of diagnostic information about ruptured AM and PMP helped to select an appropriate approach in 25 of 27 cases.

[Medicamentous bezoar following pancreaticoduodenectomy: the combined use of cholestyramine and antisecretory medications as a risk factor in pancreatic surgery]. / Pharmaco-bézoar après duodénopancréatectomie céphalique, association Choléstyramine + antisécrétoires: situation à risque en chirurgie pancréatique?

The authors describe a case of pharmaco-bezoar consisting of ingested cholestyramine which occurred post pancreaticoduodenectomy. Intestinal obstruction by a cholestyramine bezoar is a rare occurrence but is worthy of note in the post-pancreatectomy setting where there is often concomitant use of cholestyramine, proton pump inhibitors, and octreotide.

[Imaging of a thickened-wall gallbladder]. / Imagerie des épaississements de la paroi vésiculaire.

Thickening of the gallbladder wall may result from a large spectrum of pathological conditions, intrinsic as well as extrinsic to the biliary tract, and may have different appearances. Accurate diagnosis is usually established after a correlation of imaging findings, laboratory data and clinical history. US remains the initial imaging modality for the evaluation of acute right upper quadrant pain. CT and MRI are complementary to US and have an increasing role in assessing a thickened-wall gallbladder.

[Torsion of an epiploic appendage inside a Spigelian hernia: a first imaging case report]. / Torsion d'un appendice épiploïque au sein d'une hernie de Spigel: premier cas rapporté en imagerie.

We present the first case illustred in imaging of an epiploic appendage torsion inside a Spigelian hernia.

[Giant colonic or ileo-jejunal diverticulum and infra-mesocolic abdomial pseudocysts: diagnosis, pathalogical and clinical analysis]. / Diverticules géants du grêle et du côlon et formations pseudo kystiques sous-mésocoliques.

Giant diverticula of the small intestine and colon are rare. Four cases treated at our institution in the last year are reported and compared to published cases; specific features and those which differentiate them from abdominal pseudocysts are described. They most commonly present a clinical tableau similar to commonplace diverticular disease. Awareness of this unusual condition and a good CT study are the keys to diagnosis. Giant diverticula may be acquired or congenital. The acquired type is simply a more spectacular version of commonplace diverticulosis while the congenital type, having a muscular wall and myenteric plexus, is more akin to intestinal duplications. Treatment is surgical and, in the case of sigmoid giant diverticula, usually requires a colon resection similar to that required for sigmoid diverticulitis.