De Garengeot's hernia: A masked abdominal perforation.

Introduction: de Garengeot's hernias occur when an inflamed appendix is encased within a femoral sac. This is a relatively rare type of femoral hernia. As a result, there are currently no guidelines for the management of these hernias.

Traction-induced aneurysm of an accessory left hepatic artery: a potentially fatal but synchronously treatable complication of a large hiatus hernia.

A 59-year-old man presented to our surgical clinic with a long-standing history of heart burn, and upper abdominal pain. Gastroscopy showed a large sliding hiatus hernia associated with severe reflux oesophagitis. Oesophageal pH manometry revealed a high DeMeester score of 36.

Virtual touch quantification (VTq) elastography for non-invasive assessment of liver disease and its complications: what the clinician needs to know.

Liver stiffness measurement (LSM) is the most widely used non-invasive alternative to biopsy for assessing liver fibrosis in the UK. Virtual touch quantification (VTq, also known as acoustic radiation force impulse) is the principal available alternative to transient elastography (Fibroscan) and is delivered via software enhancements to standard ultrasound (US) machines. It has recently been endorsed by National Institute for Health and Care Excellence in terms of both accuracy and cost-effectiveness for use in viral hepatitis.

Implementation of a new CT colonography service: 5 year experience.

Aim: To describe our experience using a 5 year audit of computed tomography colonography (CTC) practice and identify factors that influence diagnostic performance to guide implementation in other centres.

Material And Methods: Consecutive patients referred for CTC at a single institution over a 5 year period were identified, and reporting rates and positive predictive value (PPV) calculated for small polyps, large polyps, and colorectal cancer. Diagnostic performance was compared using the Chi-squared test, and trends over time were examined with logistic regression.

Latest developments in the imaging of fibrotic liver disease.

According to the World Health Organization, liver cirrhosis accounted for 1.8% of all deaths in Europe, causing about 170,000 deaths per year. Approximately 29 million persons in the EU suffer from chronic liver disease and this trend is on the rise.

Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation.

Although most cases of acute pancreatitis are attributed to gallstones or alcohol, many remain idiopathic. The authors describe a case of acute pancreatitis in a 75-year-old gentleman who presented with acute epigastric pain, fevers and shortness of breath. Serum amylase was 2164.

'The ins and outs of abdominal pain': a case report of a transomental internal hernia.

We present the case of a 46-year-old man admitted with acute abdominal pain with no obvious cause despite simple investigations. Further imaging revealed a rare transomental internal hernia. At exploratory laparotomy, the hernia was released, no bowel resection was required and the patient was discharged 2 days later.

Subjective and objective quality assessment in wireless teleultrasonography imaging.

Mobile Robotic teleultrasonography is an emerging technology that can be applied in different clinical settings for remote ultrasound scanning without the need of the expert at the point of care. Guaranteed medical image quality for diagnostic purposes and their delivery in bandwidth limited wireless environments is a challenging issue. In this paper we present some of the subjective and objective image analysis acquired from a robotic teleultrasonography system operated remotely by the expert to provide an assessment of these medical imaging measures for such advanced wireless telemedical system.

An unusual cause of obstructive jaundice.

An 80-year-old Caucasian woman presented with a 3-week history of painless jaundice, pruritis, dark urine and weight loss. Blood analysis demonstrated an obstructive jaundice pattern. A CT scan demonstrated a gas-filled duodenal diverticulum arising from the second part of the duodenum.

Musculoskeletal manifestations of sickle cell disease.

Sickle cell disease results from the presence of abnormal beta globin chains within hemoglobin and may be manifested in anemia, vaso-occlusion, and superimposed infection. The gene that causes sickle cell disease is particularly prevalent in populations of African origin; approximately 8% of African Americans and 40% of the members of some African tribes carry the gene for hemoglobin S. Over time, the disease produces various musculoskeletal abnormalities as a result of chronic anemia; these include marrow hyperplasia, reversion of yellow marrow to red marrow, and, occasionally, extramedullary hematopoiesis.

False aneurysm of the pancreaticoduodenal artery complicating therapeutic endoscopic retrograde cholangiopancreatography.

A 76-year-old woman underwent two endoscopic retrograde cholangiopancreatography (ERCP) procedures for palliation of a carcinoma of the pancreas. At the first procedure a pre-cut sphincterotomy was performed because deep cannulation of the biliary tree was impossible. An endoscopic plastic biliary stent was inserted at the second ERCP.

Recent advances in small-bowel imaging: a review.

This review outlines technical advances in imaging of the small bowel. These include enhancement characteristics of normal bowel mucosa in computed tomography, contrast agents in magnetic resonance imaging, contrast ultrasonography, small-bowel transit measurements by radionuclide imaging, and enteroscopy. Subsequently, the application of these in clinical problem areas, including small-bowel obstruction, bleeding, and Crohn and celiac disease, will indicate the excellent potential of computed tomography, magnetic resonance imaging, and enteroscopy in particular.

The value of prone imaging in CT pneumocolon.

Aim: To evaluate the value of prone imaging in computed tomography pneumocolon.

Materials And Methods: In the U.K.

Occult sphenoid sinusitis presenting clinically as parotid swelling: a case report.

A case of occult sphenoid sinusitis was diagnosed by an MRI scan in a patient who presented clinically with meningism and unilateral parotid swelling. Although the patient improved with a prolonged course of antibiotics complete resolution occurred only after surgical drainage of the affected sinus.

Barium enema preparation: a study of low-residue diet, "Picolax' and 'Kleen-Prep'.

A prospective, randomized three-arm trial is presented of 150 consecutive patients attending for double-contrast barium enema (BE). This compares 'Picolax' (a combined stimulant and osmotic agent), 'Picolax' following a 3 day low-residue diet and 'Kleen-Prep' (a polyethylene-glycol osmotic agent). Faecal clearance, mucosal coating and colon fluid were scored in four colonic segments by two radiologists working independently and blinded to the preparation used.

Paradoxical puborectalis contraction is a feature of constipation in patients with multiple sclerosis.

Objective: To study the disturbed anorectal physiology associated with constipation in multiple sclerosis.

Methods: Anorectal function in 10 patients with clinically definite multiple sclerosis and constipation has been compared with 10 normal persons and 11 patients with idiopathic constipation, without multiple sclerosis.

Results: All 10 constipated patients with multiple sclerosis had difficulty evacuating barium paste during defaecography.

The use of air or CO2 as insufflation agents for double contrast barium enema (DCBE): is there a qualitative difference?

One hundred consecutive out-patients referred for double contrast barium enema (DCBE) were randomized in a double-blind prospective study to receive either air or CO2 as an insufflation agent. Each examination was performed by the same radiologist and radiographer. The two groups were equally matched for age and sex.

Stapled laparoscopic rectopexy for rectal prolapse.

The widespread success of laparoscopic cholecystectomy has led to the development of a wide range of laparoscopic surgical procedures. Procedures for treating rectal prolapse (Procidentia) may constitute some of the best applications for colorectal laparoscopic techniques. A technique of laparoscopic rectopexy performed using the endo-stapler is described.

Partial malrotation associated with pseudo-obstruction of the small bowel.

Intestinal pseudo-obstruction is defined as a syndrome in which there are signs and symptoms of intestinal obstruction without an actual obstructing lesion. In many cases it is associated with other disease entities but may be idiopathic. We report a case associated with partial malrotation of the gut which has not been described in the literature before.