Pneumoretroperitoneum Associated with "Dirty Mass": An Unusual Case of Rectal Perforation.

Perforation of the rectum requires early recognition and treatment. The diagnosis of rectal perforation is sometimes difficult owing to non specific clinical presentation, especially in elderly patients, in whom, in case of acute abdomen, Computed Tomography (CT) is increasing used as first diagnostic procedure [1]. Several CT signs of gastrointestinal perforation have been described [2, 3]. Recently another CT finding related to colonic perforation called " dirty mass" has been reported [4]. We present a case of extraperitoneal rectal perforation secondary to colonoscopy in which CT demonstrated the presence of a focal collection of extraluminal fecal matter ("dirty mass") associated with pneumoretroperitoneum.

Computed Tomographic Detection of Toothpick Perforation of the Jejunum: Case Report and Review of the Literature.

Foreign body ingestion is commonly encountered in the emergency department. Although in most cases, the ingested object will pass uneventfully in the feces [1], ingestion of sharp foreign bodies such as dental plates, sewing needles, toothpicks, fish bones and chicken bones carries increased risk of gastrointestinal perforation [2, 3, 4]. The use of toothpicks as both tooth-clearing implements and eating utensils increase the likelihood of toothpick unintentional ingestion [5]. Toothpicks account for 9% of reported foreign bodies ingested [6]. These pointed wooden bodies when accidentally swallowed are associated with higher risk of complications, such as gastric, small bowel or colonic perforation, obstruction, colonic impaction, gastrointestinal bleeding, subphrenic abscess, fistula formation, sepsis and/or death due to the damaged caused by the sharp pointed ends [7, 8, 9]. Unfortunately, many patients who ingested such objects fail to remember the mis-swallowing event when symptoms of perforation develop, making diagnosis problematic. We present a case of jejunal perforation secondary to an ingested wooden toothpick correctly diagnosed with Computed Tomography (CT).

Color power Doppler US and contrast-enhanced US features of abdominal solid organ injuries.

Utilization of color power Doppler and sonographic contrast agents to basic ultrasound (US) further improve the detection and characterization of abdominal injuries, increasing the diagnostic accuracy and value of US as an important technique in the evaluation of the abdominal trauma. This paper provides an illustrated summary of our clinical experience with color power Doppler US (CD-US) and contrast-enhanced US (CE-US) in the evaluation of abdominal solid organ injuries, involving 32 documented cases over a 2-year period. The findings of the CD-US and CE-US were compared with those provided by state-of-the-art contrast-enhanced multidetector 16-row CT.