Three-dimensional computed tomography rendering of pedunculated colon polyp: new "clapper-bell" sign pedunculated polyp at 3D computed tomography.

The incidental detection of a tubulovillous adenoma at a contrast-enhanced computed tomography (CECT) with nondedicated protocol, performed in emergency conditions, is an uncommon finding. We report a case of a woman presenting with a subocclusive episode. A CECT scan was performed, and a pedunculated polyp could be appreciated at 3D-reconstruction images. A particular depiction of pedunculus of the polypoid lesion, resemble a clapper-bell, could help to define the vegetating lesion at the volume-rendering reconstruction images. This case emphasizes the fundamental role of postprocessing in the clinical practice to improve the diagnostic accuracy of abdominal CT scan. In addition, a potential new radiologic sign, the "clapper-bell sign", is proposed, as literature about the appearance of a polyp at CECT, performed without a dedicated protocol for colonoscopy, is poor.

Megacolon for a giant faecaloma with unlucky outcome: case report and review of the literature.

We herein report a case of megacolon with fecaloma in an 83-year-old man who presented with constipation, no intestinal occlusion, and a left hydroureteronephrosis, with A.S.A. 4. The patient asymptomatic, was treated Primariely with laxatives. During the conservative therapy the patient presented an abrupt abdominal distension with a bowel obstruction and abdominal compartment syndrome. After the laparotopy and a Hartmann left colon resection the patient died for cardiovascular and metabolic complications. The aim of this report is to give a brief review of this entity and discuss the treatment options for these cases.

New type of asymptomatic congenital portosystemic shunt.

Congenital extrahepatic portosystemic shunt (CEPS) is an extremely rare anomaly. In these malformations splanchnic blood bypasses the liver and drains into the systemic circulation through the inferior vena cava (IVC) or the left renal vein (LRV). Extrahepatic shunts may be divided into type 1 [end-to-side mesenterico-caval fistula with congenital absence of the portal vein (PV)] and type 2 (partial portocaval shunt caused by side-to-side mesenterico-caval fistula with normal or hypoplasic PV). Type 2 shunts typically are wholly extrahepatic between the PV or its right branch and the retrohepatic IVC. This report describes an asymptomatic case of CEPS not previously documented and not classifiable as type 1 or 2. CT revealed a normal PV with communication between the inferior mesenteric vein (IMV) and the LRV. The inferior mesenteric vein appeared tortuous, abnormally long and with a large calibre, and presented a connection with the LRV, in addition to a normal confluence into the splenic vein. Colour Doppler revealed hepatopetal normal flow in the PV and superior mesenteric vein with mild portal hypertension and an inversion of flow in the IMV directed to the LRV. Biochemical parameters showed a normal liver function without hyperammonaemia.