Preoperative prediction of inadvertent enterotomy during adhesive small bowel obstruction surgery using combination of CT features.

OBJECTIVES: The purpose of this study was to identify the preoperative CT features that are associated with inadvertent enterotomy (IE) during adhesive small bowel obstruction (ASBO) surgery. METHODS: From January 2015 to December 2019, all patients with ASBO who underwent an abdominal CT were reviewed. Abdominal CT were retrospectively reviewed by two radiologists with a consensus read in case of disagreement. IE during ASBO surgery was retrospectively recorded. Univariate and multivariate analyses of CT features associated with IE were performed and a simple CT score was built to stratify the risk of IE. This score was validated in an independent retrospective cohort. Abdominal CT of the validation cohort was reviewed by a third independent reader. RESULTS: Among the 368 patients with ASBO during the study period, 169 were surgically treated, including 129 ASBO for single adhesive band and 40 for matted adhesions. Among these, there were 47 IE. By multivariate analysis, angulation of the transitional zone (OR = 4.19, 95% CI [1.10-18.09]), diffuse intestinal adhesions (OR = 4.87, 95% CI [1.37-19.76]), a fat notch sign (OR = 0.32, 95% CI [0.12-0.85]), and mesenteric haziness (OR = 0.13, 95% CI [0.03-0.48]) were independently associated with inadvertent enterotomy occurrence. The simple CT score built to stratify risk of IE displayed an AUC of 0.85 (95% CI [0.80-0.90]) in the study sample and 0.88 (95% CI [0.80-0.96]) in the validation cohort. CONCLUSION: A simple preoperative CT score is able to inform the surgeon about a high risk of IE and therefore influence the surgical procedure. KEY POINTS: • In this retrospective study of 169 patients undergoing abdominal surgery for adhesive small bowel obstruction, 47 (28%) inadvertent enterotomy occurred. • A simple preoperative CT score enables accurate stratification of inadvertent enterotomy risk (area under the curve 0.85). • By multivariable analysis, diffuse intestinal adhesions and angulation of the transitional zone were predictive of inadvertent enterotomy occurrence.

Abdominal symptoms as initial manifestation of COVID-19: a case series / Sintomas abdominais como manifestação inicial da COVID-19: uma série de casos

ABSTRACT The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.

RESUMO A COVID-19 foi declarada uma pandemia no início de 2020. Constatou-se, inicialmente, que as principais manifestações desse novo vírus ocorrem por meio de sintomas respiratórios e constitucionais. A tomografia do tórax foi eleita o exame de imagem para avaliar a extensão do comprometimento pulmonar e como um fator preditivo do prognóstico para a doença. No entanto, à medida que novos estudos são produzidos, o envolvimento gastrointestinal da COVID-19 torna-se mais evidente, com relatos de pacientes que manifestaram principalmente ou apenas sintomas gastrointestinais no decorrer da doença. Em alguns casos, a investigação inicial é realizada no pronto-socorro, com tomografia computadorizada do abdome. Relatamos uma série de casos de dez pacientes que compareceram ao serviço de emergência da instituição com uma queixa principal gastrointestinal e foram submetidos inicialmente a uma tomografia computadorizada de abdome como primeira investigação. Embora a maioria dos pacientes não tenha apresentado alterações significativas nas imagens abdominais, eles apresentaram achados pulmonares visualizados nas bases pulmonares, que depois foram caracterizadas como achados pulmonares típicos de COVID-19 nas tomografias de tórax subsequentes. Apenas um paciente apresentou achados atípicos para COVID-19 na tomografia. Todos os pacientes tiveram reação em cadeia da polimerase em tempo real positiva para o novo coronavírus. É muito importante alertar os radiologistas, principalmente os radiologistas abdominais, da possibilidade de sintomas gastrointestinais isolados no contexto da COVID-19. Além disso, deve ser um hábito para todos os radiologistas avaliar as bases pulmonares nas tomografias de abdome, local comumente afetado pela COVID-19.

CT Diagnosis of Pancreatic Cystic Disease / 实用放射学杂志

Objective To identify the differential diagnosis value of CT in the pancreatic cystic disease.Methods 77 cases of pancreatic cystic disease diagnosed by CT scan were retrospectively analysed.Results CT recognized the different imaging features about cystic disease of malignant pancreatic tumor,metastatic cystic disease,begin-malignant pancreatic cystadenoma and acute/chronic pancreatitis.Conclusion Mastering the CT features of pancreatic cystic disease may give rise to the differential diagnosis,which is useful to the clinical decision.

Prognostic Reevaluation of CT and Clinical Criteria for Acute Pancreatitis / 实用放射学杂志

Objective To reassess the value of CT and clinical criteria as prognostic and severity indicators in acute pancreatitis and to investigate the correlation between them.Methods Of 65 cases of acute pancreatitis,the hospitalization days,fevering days and entire complications (including local and systemic complications)were regarded as clinical endpoints.CT criteria included Balthazar's plain CT scan score,necrosis score,CT severity index(CTSI) and London's PSI score.Clinical criteria included Ranson and APACHE Ⅱscore.Using analysis of variance,t-test and multiple linear regression analysis,the correlation between each criteria and the three clinical endpoints was examined as well as the relation between CT and clinical criteria.The power of each criteria and combination of CT and clinical criteria in predicting entire complications of AP was assessed and compared by using ROC analysis.Results The mean scores of PSI,Ranson and APACHE Ⅱamong three groups classified according to entire complications were significantly different.Except Balthazar's plain CT scan criteria,each criteria's mean scores in group with local complications was signifiantly higher than that in group without and entire complications was significantly more in sever group than that in mild group.Mean hospitalization days and fevering days were significantly longer in sever group than that in mild group with Ranson Score.PSI and Ranson score had linear correlation with fevering days,and Ranson score had linear correlation with hospitalization days.In CT criteria,a linear correlation was only found between PSI and Ranson score.ROC analysis showed the Az of Ranson score was the largest,and there was no increase in the Az when CT criteria were added to clinical criteria.Conclusion The predictive value of Ranson score and PSI are superior to that of others.Clinical criteria is superior in predicting systemic complications,whereas CT is superior in predicting local complications.There is no improvement in predicting entire complications of AP when CT criteria are added to clinical criteria.The findings of plain CT scan is found to be some laggard compared with that of clinic.CT scan and short follow-up are important in the evaluation of AP.