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Anorectal
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
SMALL PRINT: urinalysis, ultrasound, barium enema, other imaging. FBC/ESR/CRP: WCC may be raised in abscess and Crohn’s disease. ESR/CRP raised in these and carcinoma.Proctoscopy valuable if pain allows (specialist might also take biopsy).Faecal calprotectin: may help in diagnosing Crohn’s disease.Urinalysis: pus cells and blood may be present in prostatitis or invasive bladder tumour.Ultrasound of pelvis if pelvic examination reveals a mass. Barium enema may be necessary to assess possible bowel involvement. In obscure cases, specialists may request other forms of imaging.
Clinical Spectrum of Amebiasis in Adults
Published in Roberto R. Kretschmer, Amebiasis: Infection and Disease by Entamoeba histolytica, 2020
Given the pseudotumoral appearance of ameboma of the colon, this form of intestinal invasive amebiasis is the most frequently confused with other diseases, mainly with carcinoma of the colon. When localized in the rectosigmoid, endoscopy and the presence of amebic trophozoites in the vicinity of the lesion will establish the diagnosis. When localized elsewhere in the colon, a barium enema is useful in diagnosis, as it can reveal the coexistence of inflammatory and ulcerative lesions in the neighboring areas of the lesion. Colonoscopy and biopsy can confirm the correct diagnosis beyond doubt. In nonendemic areas an ameboma may rarely resemble the granulomatous and/or proliferative lesions caused by schistosomiasis or tuberculosis.19 The presence, or rather the absence, of antiamebic antibodies may aid in the differential diagnosis in cases where carcinoma is suspected.
Large Bowel Obstruction Management
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Pamela Daher-Tobia, Carlos V.R. Brown
The most common etiology of LBOs is colorectal malignancy (50%), followed by complications of diverticular disease and strictures (10%–20%), volvulus of the sigmoid and cecum (10%–17%), and less commonly, inflammatory bowel strictures, extrinsic compression by carcinomatosis or extracolonic malignancies, and finally, adhesions (Yeo et al., 2013). Evidence to date conclusively supports CT scanning as the gold standard for the initial diagnosis and possible staging if applicable, with a sensitivity and specificity of over 90%, which increases with addition of combined IV, PO, and rectal contrast routes. Barium enema can be a useful adjunct at time of diagnosis in stable patients, as it can provide additional information regarding the size and tortuosity of obstructing lesions.
Acute acalculous cholecystitis in an infant after gastroschisis closure
Published in Baylor University Medical Center Proceedings, 2023
Irfan Shehzad, Nicholas Nelson, Niraj Vora, Hale Wills, Krista Birkemeier, Vinayak Govande
On DOL 97, ultrasound showed a decrease in the size of the pericholecystic abscess. Ceftazidime was stopped after completion of a 10-day course and ampicillin was continued. One month after cholecystostomy tube placement (DOL 121), percutaneous cholangiogram confirmed the absence of biliary leak and the cholecystostomy tube was removed without complication (Figure 1). Barium enema was later performed and demonstrated intestinal stenosis at a previous anastomosis site, which prompted an exploratory laparotomy, adhesion lysis, and resection of the prior small bowel anastomosis with formation of a new ileoileostomy. Ampicillin was continued for 6 weeks. On DOL 132, oral feed with expressed breast milk was started at 10 mL/kg/day and advanced slowly to reach full feeds at 160 mL/kg/day. The patient was subsequently discharged home on DOL 167 on oral and nasogastric tube feeds with follow-up with her pediatrician and neonatal intensive care unit high risk, pediatric dietary, gastroenterology, and surgery clinics as an outpatient.
Abnormal findings on abdominopelvic cross-sectional imaging in patients with microscopic colitis: a retrospective, multicenter study
Published in Scandinavian Journal of Gastroenterology, 2022
Andree H. Koop, Ahmed Salih, Mohamed Omer, Josh Kwon, Hassan M. Ghoz, Matthew McCann, June Tome, William C. Palmer, Darrell S. Pardi, Fernando F. Stancampiano
Our review of the literature revealed no established association between MC and abnormalities on CT or MR imaging, but only small case series in the late 1980s and early 1990s that reported findings on barium enema in patients with MC [9]. The first study described a patient with colon nodularity on barium enema, followed by a normal endoscopic evaluation [9,10]. In the second study of 5 patients with collagenous colitis, 3 had abnormal findings on barium enema described as mucosal granularity or nodularity of the colon [11]. A clinical review reported mural thickening of the colon on CT imaging in some patients with MC [8]. Although cross-sectional imaging is generally not recommended in the evaluation of microscopic colitis, CT or MR enterography are indicated in patients with chronic diarrhea of unclear etiology, especially patients with alarm features or abnormal laboratory tests [2]. This is helpful to exclude both luminal causes, such as Crohn’s disease, or extraluminal causes of diarrhea [12]. The majority of patients in this study underwent cross-sectional imaging for the indication diarrhea, which we suspect was part of a comprehensive evaluation of these patients referred to tertiary medical centers [2].
Inflammatory bowel disease in Nigerian children: case series and management challenges
Published in Paediatrics and International Child Health, 2020
Idowu Senbanjo, Ayodeji Akinola, Tolulope Kumolu-Johnson, Olayinka Igbekoyi, Kazeem Oshikoya
Prior to presentation, the patient had been treated for common gastrointestinal symptoms at various health facilities. Barium enema showed dilation of the sigmoid and descending colon in association with persistent narrowing of the rectum and thickening of the normal haustra of colon at regular intervals, appearing like thumbprints projecting into the lumen, suggestive of ulcerative colitis. Colonoscopy, biopsy and histology confirmed ulcerative colitis. She was commenced on oral sulfasalazine 50 mg/kg/day in two divided doses and later with the addition of oral prednisolone 1 mg/kg/day in two divided doses. She responded well to treatment and is currently in remission. She was followed up for a while at the outpatient clinic but then defaulted.