Nonoperative Management of Perforated Diverticulitis of the Duodenum: Report of Three Cases and Review of Literature.

Duodenal diverticula are relatively frequent but complications are uncommon. The mortality rate of perforated duodenal diverticulitis is high, and its management is controversial. We report three patients with a perforated duodenal diverticulitis who were successfully treated with conservative antibiotic therapy.

A systematic review and meta-analysis of disease severity and risk of recurrence in young versus elderly patients with left-sided acute diverticulitis.

Young patients are thought to have a more severe disease course and a higher rate of recurrent diverticulitis. However, these understandings are mainly based on studies with important limitations. This review aimed to clarify the true natural history of acute diverticulitis in young patients compared to elderly patients.

Ultrasound-guided reduction of an incarcerated obturator hernia in an elderly patient.

Obturator hernia is a rare but clinically relevant cause of intestinal obstruction, usually found in elderly, thin, multiparous women. It is difficult to diagnose, leading to diagnostic delay with a high incidence of strangulation and a high mortality rate. Surgery is the only reported treatment.

Perforation of the gallbladder: a rare cause of acute abdominal pain.

An 82-year-old woman without any previous medical history arrived in the emergency department with severe pain in the entire abdomen since 5 h. Blood tests showed, apart from a CRP of 28 mg/l, no abnormalities. We decided to perform an abdominal ultrasound, which showed an easily compressible gallbladder, containing a small, mobile gallstone and free fluid in the abdomen.

[Uterine fibroids complicated by haematometra].

Background: Uterine fibroids are common, benign tumours of the myometrium. The clinical symptoms include menorrhagia, abdominal pain and subfertility.

Case Description: A 37-year-old black woman known to have uterine fibroids presented at the gynaecology outpatient clinic with abdominal pain.

Ultrasound of colon diverticulitis.

Overall, the diagnosis of diverticulitis is more reliably made by computed tomography (CT) than by ultrasound (US). However, since US is often used as a first modality in acute abdomen, it is important to be aware of the US signs of diverticulitis. Besides, in not too obese patients, US may be superior to CT.

Acute appendagitis of the ligamentum teres hepatis: clinical, ultrasound, and computed tomographic findings.

Purpose: To describe the clinical, ultrasound (US), and CT findings in three patients with acute appendagitis of the ligamentum teres hepatis.

Methods: A retrospective search of cases over a 4-year period was performed and yielded three patients with acute appendagitis of the ligamentum teres hepatis. The diagnosis was confirmed by US, CT, and clinical follow-up in all three cases.

[Radiological examinations that have disappeared].

If a radiologist from 1950 could travel in time to 2011, he or she would be baffled to see how few of the radiological examinations he was familiar with, remain. We review the radiological examinations that have disappeared since X-rays were discovered, and include the causes of their disappearance. Barium studies have mainly been replaced by endoscopy, oral cholecystography by ultrasound, and intravenous urography by CT-scan.

[Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended].

Every year, over 2500 unnecessary appendectomies are carried out in the Netherlands. At the initiative of the Dutch College of Surgeons, the evidence-based guideline on the diagnosis and treatment of acute appendicitis was developed. This guideline recommends that appendectomy should not be carried out without prior imaging.

[Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended].

Every year, over 2500 unnecessary appendectomies are carried out in the Netherlands. At the initiative of the Dutch College of Surgeons, the evidence-based guideline on the diagnosis and treatment of acute appendicitis was developed. This guideline recommends that appendectomy should not be carried out without prior imaging.

Thoracic causes of acute abdominal pain.

The origin of abdominal pain may be extra-abdominal, caused by a thoracic illness. This article illustrates the various thoracic disorders that may present with acute abdominal pain. An erroneous focus on the abdomen alone can easily lead to misdiagnosis and incorrect treatment.

Endometriosis of the posterior cul-de-sac: clinical presentation and findings at transvaginal ultrasound.

Objective: The purpose of our study was to evaluate the clinical findings and transvaginal ultrasound features of posterior cul-de-sac endometriosis.

Materials And Methods: A retrospective search of cases over a 13-year period was performed and yielded 25 patients with posterior cul-de-sac endometriosis. The diagnosis of posterior cul-de-sac endometriosis was confirmed by histology (n = 13), conventional barium enema (n = 13), colonoscopy (n = 8), CT (n = 8), MRI (n = 17), diagnostic laparoscopy (n = 14), and laparotomy (n = 13).

Infection of a malignant appendiceal mucocele masquerading as an appendiceal abscess: role of preoperative sonography and CT.

We report the case of a 71-year-old lady with a suspected appendiceal abscess in whom preoperative sonography and CT demonstrated an infected appendiceal mucocele. The lesion was surgically removed and final pathologic examination revealed malignancy. Correct recognition of the mucocele prevented a potentially disastrous percutaneous drainage.

A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy.

To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes.

Diffuse gallbladder wall thickening: differential diagnosis.

Objective: The objective of our study was to review and illustrate the various clinical entities that may cause diffuse thickening of the gallbladder wall on diagnostic imaging studies.

Conclusion: Diffuse gallbladder wall thickening may be caused by a wide range of gallbladder diseases and extracholecystic pathologic conditions. In most cases its cause can be determined by correlation of the clinical presentation and associated imaging findings.

Autoimmune pancreatocholangitis: a series of ten patients.

Background: During a 10-year period we observed 10 patients who suffered from an inflammatory-fibrosing disease mimicking pancreatic carcinoma and primary sclerosing cholangitis (PSC).

Methods: A review of the presenting features, the clinical course and the relevant literature.

Results: Ten male patients (mean age 55 years) presented with weight loss, jaundice and pruritus.

Mimics of appendicitis: alternative nonsurgical diagnoses with sonography and CT.

Objective: Our objective was to illustrate the imaging features of alternative nonsurgical disorders in patients presenting with clinical signs of appendicitis.

Conclusion: This article illustrates the sonographic and CT features of various appendicitis-mimicking conditions that are self-limiting or that can be treated conservatively. A correct imaging diagnosis of these disorders may prevent a nontherapeutic appendectomy and unnecessary hospitalization.

Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography.

Objective: The purpose of our study was to evaluate clinical findings and sonographic features of abdominal wall endometriosis and also to report its CT and MR appearance.

Materials And Methods: A computerized search of our institution's database over a 5-year period was performed, yielding 12 surgically proven cases of abdominal wall endometriosis that were retrospectively studied. All patients had undergone sonography including power Doppler examination.

MRI for clinically suspected appendicitis during pregnancy.

Objective: The purpose of this study was to evaluate whether MRI can be used to accurately diagnose or exclude appendicitis in pregnant patients with clinically suspected appendicitis.

Conclusion: Our results suggest that MRI is helpful in the examination and diagnosis of acute appendicitis in pregnant patients. MRI may therefore be a good alternative to CT in pregnant patients for whom sonographic findings are nondiagnostic.

Appendix in children with cystic fibrosis: US features.

Purpose: To evaluate the ultrasonographic (US) appearance of the appendix in children with cystic fibrosis but who were asymptomatic for appendicitis.

Materials And Methods: Between March 2001 and March 2002, 31 children (14 boys, 17 girls; mean age, 9.5 years; range, 2-16 years) with cystic fibrosis underwent graded-compression US of the appendix.

Ultrasonography of the acute abdomen: gastrointestinal conditions.

Although multislice, helical CT is increasingly replacing ultrasonography for the evaluation of patients with acute abdominal pain, ultrasound does have certain specific advantages over CT. This article discusses the advantages of ultrasound in imaging of the acute abdomen, exploring such areas as appendicitis, ileocecal Crohn's disease, infectious ileocolitis and infectious ileocecitis, mesenteric lymphadenitis, cecal carcinoma, sigmoid diverticulitis, right-sided colonic diverticulitis, and perforated peptic ulcer.