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.

[No hocus POCUS: high standards should be set for point-of-care ultrasonography].

Point-of-care ultrasonography (POCUS) was initially limited to simple applications such as diagnosing ascites, sampling pleural fluid and guiding venous access. Use of POCUS is currently on the rise. As radiologists, we endorse the use of ultrasonography as the stethoscope of the future, but we make some critical comments.

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.

Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis.

Background: Routine colonoscopy was traditionally recommended after acute diverticulitis to exclude coexistent malignancy. Improved CT imaging may make routine colonoscopy less required over time but most guidelines still recommend it. The aim of this review was to assess the role of colonoscopy in patients with CT-proven acute diverticulitis.

Image-guided posterior transperineal drainage for presacral abscess: An analysis of 21 patients.

Objective: The purpose of this study was to retrospectively evaluate the safety and efficacy of posterior transperineal drainage in patients with presacral abscess.

Materials And Method: The records of 21 patients (14 men, 7 women; mean age: 62.1±10 years) who underwent posterior transperineal drainage for the treatment of presacral abscess, either using fluoroscopy or computed tomography guidance, were retrospectively reviewed.

A systematic review and meta-analysis of outpatient treatment for acute diverticulitis.

Background: The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world.

Purpose: Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis.

Methods: PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound.

A rare case of Waterhouse- Friderichsen syndrome during primary Varicella zoster infection.

Primary Varicella zoster virus infection in adults is associated with a higher risk of complications when compared with the benign disease course of primary infection during childhood. We present a rare complication of adult primary Varicella zoster in the form of acute, irreversible adrenal insufficiency due to bilateral adrenal haemorrhage, which is also known as the WaterhouseFriderichsensyndrome.

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.

[Treating physicians can perform simple ultrasounds; triage ultrasonography should be reserved for radiologists].

We feel that, in trained hands, point-of-care ultrasonography by non-radiologists is of value to patient care. However, more extensive ultrasonography, i.e.

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.

Imaging of patients with clinically suspected appendicitis in the Netherlands: conclusions of a survey.

The aim of this study was to summarize the extent of variation in imaging strategies in patients clinically suspected of having appendicitis. By means of a written survey, the policies for the imaging management of patients clinically suspected of having appendicitis in the Netherlands were inventoried. A questionnaire was sent to the departments of surgery and radiology of all 105 Dutch hospitals, including the 8 academic medical centres, in March 2006.

[Abdominal ultrasound: a task for the radiologist].

In the Netherlands, ultrasound (US) as a primary, symptom-directed diagnostic tool, is used mainly by radiologists and not by internists; there are good reasons for this. It guarantees concentration of expertise in US as well as in CT and MRI, which makes integrated imaging possible. It also guarantees the continuous availability of expertise, optimal digital accessibility, clearly assigns the responsibility, and minimises the radiation risk.

[Acute abdominal pain in the third trimester of pregnancy caused by adnexal torsion based on a small cystic adenoma].

A 25-year-old woman presented in the third trimester of pregnancy with severe abdominal pain in the lower right abdominal quadrant. Differential diagnosis included urolithiasis, adnexal torsion and appendicitis. A definitive diagnosis could not be made based on clinical and laboratory examination.