Pattern and distribution of colonic diverticulosis: analysis of 2877 barium enemas in Thailand.

AIM: To determine the pattern and distribution of colonic diverticulosis in Thai adults. METHODS: A review of the computerized radiology database for double contrast barium enema (DCBE) in Thai adults was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded. The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined. The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were reported. Factors influencing the presence of colonic diverticulosis were evaluated. RESULTS: A total of 2877 suitable DCBE examinations were retrospectively reviewed. The mean age of patients was 59.8 ± 14.7 years. Of these patients, 1778 (61.8%) were female and 700 (24.3%) were asymptomatic. Colonic diverticulosis was identified in 820 patients (28.5%). Right-sided diverticulosis (641 cases; 22.3%) was more frequently reported than left-sided diverticulosis (383 cases; 13.3%). Pancolonic diverticulosis was found in 98 cases (3.4%). The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were 1.5% (42 cases), 0.4% (12 cases), and 0.03% (1 case), respectively. There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients (28.3% vs 28.6%, P = 0.85). DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals (29.5% vs 25.3%, P = 0.03). Change in bowel habit was strongly associated with the presence of diverticulosis (a relative risk of 1.39; P = 0.005). The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals (P > 0.05). CONCLUSION: Colonic diverticulosis was identified in 28.5% of DCBE examinations in Thai adults. There was no association between the presence of diverticulosis and gender or age.

Colorectal cancer screening by double contrast barium enema in Thai people.

PURPOSE: The incidence of colorectal cancer (CRC) has been increasing in Asian countries including Thailand. Double contrast barium enema (DCBE) is one of the investigation tools used in CRC screening. This study aimed to determine the incidence of colorectal neoplasm detected at screening by DCBE in Thai people. METHODS: The computerized radiology database of screening DCBE in Thai adults between June 2009 and October 2011 at the Faculty of Medicine, Siriraj Hospital, was reviewed. DCBE examination performed in a surveillance program after curative CRC resection or the removal of colorectal polyps was also considered as a screening DCBE. RESULTS: A total of 819 screening DCBEs performed during this 28-month period were analyzed. The mean age of patients was 59.8 ∓ 13.6 years. Of the total, 467 (57%) were male. A family history of CRC and a previous history of curative CRC resection or polyp removal were noted in 34 patients (4%) and 124 patients (15%), respectively. A total of 31 patients (3.8%; 95%CI = 2.7%-5.3%) were reported to have colorectal polyp or mass demonstrated on DCBE. Of these, follow-up endoscopy was performed in 20 cases (65%). According to pathological results, the incidence of advanced adenoma and CRC detected at screening DCBE was 0.7% (95%CI = 0.3%-1.6%; n=6) and 0.4% (95%CI = 0.1%-1.1%; n=3), respectively. CONCLUSIONS: The screening DCBE performed in Thai adults had a diagnostic yield of 0.7% for advanced adenoma and 0.4% for CRC.

Wall thickness and outer diameter of the normal appendix in adults using 64 slices multidetector CT.

OBJECTIVE: Determine wall thickness and outer diameter of the normal appendix in adults using 64 slices multidetector CT MATERIAL AND METHOD: A retrospective review of 538 patients (190 men, 348 women; mean age, 56.5 years +/- 15.2 SD) who were sent for abdomino-pelvic CT without clinical suspicion of acute appendicitis was conducted. Two radiologists blinded to the presented patient's history of appendectomy interpreted CT images regarding the visualization of the appendix, location, luminal contents and presence of appendicoliths. The maximum outer diameter and two walls thickness of the visualized appendices were measured. RESULTS: The sensitivity specificity, positive and negative predictive value, and accuracy for visualization of the appendix were 90.8%, 100%, 100%, 76.5% and 92.9% for reader 1 and 97.3%, 97.6%, 99.3%, 91.7% and 97.4% for reader 2. The mean maximum outer diameter of the appendix was 6.6 mm +/- 1.5 (range, 3.4-14.0 mm). The mean two walls thickness of the appendix was 4.4 mm +/- 1.0 (range, 1.6-8.0 mm). CONCLUSION: The normal appendix is frequently identified at 64 slices MDCT. Contrast to maximum outer diameter, normal two walls thickness of the appendix is infrequently exceeding the threshold of 6 mm.

Diagnostic performance of CT findings in differentiation of perforated from nonperforated appendicitis.

OBJECTIVE: To assess performance of CT finding in differentiation of perforated from non-perforated appendicitis in Siriraj hospital, Bangkok, Thailand and evaluate accuracy of each finding by using multidetector row computer tomography (MDCT). MATERIAL AND METHOD: Between June 2006 and May 2009, all adult patients (age more than 15 years) who had a diagnosis of acute appendicitis in Siriraj Hospital that was confirmed by pathology or surgical records and received a CT scan whole abdomen or lower abdomen with contrast administration before surgical or medical treatment were included in this study. The 48 consecutive CTs of whole or lower abdomen examinations were retrospectively reviewed by two radiologists. Sensitivity specificity, and accuracy of CT compared with pathologic or surgical findings. RESULTS: In 48 patients, 21 patients of non-perforated appendicitis and 27 patients of perforated appendicitis were enrolled. The CT findings of abscess, extraluminal appendicolith, and extraluminal air had the highest specificities for perforated appendicitis, 95.24%, 100%, 95.24%, respectively. The best accurate finding was defect in enhancing appendiceal wall. The CT findings of enlarged mesenteric lymph nodes at right lower quadrant region and defect in enhancing appendiceal wall had the highest sensitivities, 88.88% and 88.46%, respectively. Group 3 of combined specific findings had the best sensitivity (92.59%) and accuracy (83.3%). CONCLUSION: Multi-detector CT can help to differentiate perforated from non-perforated appendicitis.