Computed tomography colonography: a retrospective analysis of outcomes of 2 years experience in a district general hospital.

Background: Colonoscopy is the gold-standard investigation for direct luminal visualization of the large bowel. Studies have shown the efficacy of computed tomography colonography (CTC) is equivalent to colonoscopy in both cancer and polyp detection.

Methods: A retrospective review of patients undergoing CTC from January 2013 to October 2014 was performed.

Dysgenesis of the inferior vena cava associated with deep venous thrombosis and a partial Protein C deficiency.

Dysgenesis of the inferior vena cava is rare but it is being increasingly diagnosed by cross-sectional imaging techniques. Patients are usually asymptomatic with abnormalities detected incidentally. An 11 year old boy presented with a 10 day history of fever, vomiting and abdominal pain, which progressed to his back and lower limbs.

Simultaneous xanthogranulomatous cholecystitis and gallbladder cancer in a patient with a large abdominal aortic aneurysm.

There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis.

Traumatic splenectomy in a cirrhotic patient with hepatitis C and alcoholic liver disease.

Non-operative management is the management of choice for haemodynamically stable patients with blunt splenic injury. However, coexistent liver cirrhosis poses significant challenges as it leads to portal hypertension and coagulopathy. A 52-year-old man sustained blunt abdominal trauma causing low-grade splenic injury.

Computed tomography findings of bowel wall thickening: its significance and relationship to endoscopic abnormalities.

Introduction: The aim of this study was to conduct retrospective analysis of abdominopelvic computed tomography (CT) reports, identifying those patients in whom bowel wall thickening (BWT) was observed, and to correlate these reports with subsequent endoscopic evaluation.

Methods: Formal reports for all patients undergoing abdominopelvic CT between February 2007 and September 2009 were reviewed. Where patients were identified as having colorectal 'wall thickening', results of subsequent endoscopic evaluations were documented.

Krukenberg tumour arising from adenocarcinoma of the gastro-oesophageal junction in a 28-year-old female presenting as lower abdominal swelling mimicking an inguinal hernia.

Krukenberg tumours arising from gastro-oesophageal adenocarcinomas prior to the fourth decade are extremely rare. The authors present the case of a 28-year-old patient who was then 4 years of age, residing close to the Chernobyl nuclear reactor at the time of the nuclear disaster in 1986, and was found to have late-stage Krukenberg tumours from a gastro-oesophageal primary. Her presentation with right groin pain initially raised a suspicion of an occult groin hernia.

Intracranial hypotension secondary to spinal arachnoid cyst rupture presenting with acute severe headache: a case report.

Introduction: Headache is a common presenting complaint and has a wide differential diagnosis. Clinicians need to be alert to clues that may suggest an underlying secondary aetiology. We describe a novel case of headache secondary to intracranial hypotension which was precipitated by the rupture of a spinal arachnoid cyst.

Acute mesenteric ischaemia on unenhanced computer-tomography.

We present a 39-year old man with mesenteric ischaemia. The initial unenhanced images of the, non-oral contrast CT abdomen clearly demonstrated increased density in a significant length of the small bowel and in the veins of the adjacent mesentery. Mesenteric ischaemia is a difficult diagnosis both clinically and radiologically and we demonstrate the potential benefits of an unenhanced abdominal scan (often left out if a contrast enhanced scan is to be performed) and the omission of oral bowel contrast in emergency scans.

Hepatic fascioliasis at a London hospital--the importance of recognising typical radiological features to avoid a delay in diagnosis.

Hepatic fascioliasis is a zoonosis caused by the trematode Fasciola hepatica, which can cause hepatobiliary disease in humans via the ingestion of contaminated water or aquatic vegetables. Reported cases of human infection with F. hepatica arise in regions where cattle are raised, with particular abundance in South America and the Middle East.

A life-threatening complication of Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome predisposes to the development of vascular malformations, which may present as life-threatening haemorrhage. This article presents a patient with Ehlers-Danlos syndrome in whom spontaneous rupture of an unusual arteriovenous fistula occurred. This rare diagnosis can be reached through close attention to the history and examination.

Postpartum pneumoperitoneum and peritonitis after water birth.

Pneumoperitoneum (the presence of free gas in the peritoneal cavity) usually indicates gastrointestinal perforation with associated peritoneal contamination. We describe the unusual case of a 28-year-old female, who was 7 days postpartum and presented with features of peritonitis that were initially missed despite supporting radiological evidence. The causes of pneumoperitoneum are discussed.

Pseudotumoural gastric lesion caused by fish bone perforation.

We report the case of a 34-year-old previously fit and healthy male who presented to the accident & emergency department with non-specific abdominal pain. The patient proceeded to undergo laparotomy at which a large mass was found adjacent to the stomach. The impression at surgery was of a lymphoma or gastric carcinoma though CT had reported the likelihood of a fish bone or foreign body causing duodenal perforation.

Assessment of the common bile duct before cholecystectomy: a direct comparison between ultrasonography and intravenous cholangiography.

Sixty-seven consecutive patients undergoing cholecystectomy for symptomatic gallstones were investigated by both ultrasonography (US) and intravenous cholangiography (IVC). This provided the opportunity to compare these methods for assessing the common bile duct (CBD) preoperatively for stones. The results were correlated with a subsequent definitive procedure that formed the diagnostic standard in each case.

Intracranial extension of orbital pseudotumour.

Radiologically demonstrable intracranial extension of orbital pseudotumour is rare, and only four cases appear to have been reported previously in the literature. A review of the computed tomographic (CT) images of 90 biopsy proven cases of orbital pseudotumour seen over a 10 year period revealed eight cases with intracranial meningeal spread.

Digital subtraction angiography (DSA) of the extracranial cerebral vessels: a direct comparison between intravenous and intra-arterial DSA.

Fifty patients being investigated for ischaemic cerebrovascular disease underwent both intravenous digital subtraction angiography (IV-DSA) and intra-arterial arch digital subtraction angiography (arch-DSA) to enable a direct comparison to be made between the two techniques. The overall quality of the images obtained by arch-DSA was better than that obtained by IV-DSA, but there was no significant difference between the number and gradation of stenoses detected by the two techniques. No significant stenosis was missed by IV-DSA and the technique was found to be sufficiently accurate for it to be used as a screening procedure for carotid bifurcation stenoses suitable for carotid endarterectomy.

Preliminary experience with the Berger neurobiopsy device for ultrasound guided aspiration and biopsy of intracranial lesions.

Our preliminary experience is presented in the use of the Berger neurobiopsy device for ultrasound localization and biopsy of intracranial lesions through a burr hole. The apparatus and technique are described, along with the results of its use in the first 49 patients. In these patients 43 tumours were biopsied, all except one successfully.