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Other Tumours of the Colon and Rectum
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Diagnosis of small bowel tumours is difficult, and this difficulty is strongly correlated to the type, location and size of the lesion. Blood tests are generally unhelpful in the diagnosis of small bowel neoplasms, except for neuroendocrine tumours where serum chromogranin A, serum 5-hydroxy tryptamine and the measurement of 24-h urinary excretion of 5-hydroxyindoloacetic acid (5-HIAA) may be useful in detecting a carcinoid tumour. Endoscopy (push- or balloon-enteroscopy) is applicable for proximal tumours and offers the opportunity to biopsy, with the advantage of a tissue diagnosis. Wireless capsule endoscopy is able to visualise the entire small bowel, but it cannot perform a tissue biopsy. Computed tomography (CT), CT enterography and MRI enterography have an important role in the diagnosis of intestinal tumours and lymph node involvement as well as staging and in identifying potential complications, such as perforation or intussusception. Positron emission tomography (PET) using radiolabelled 18 fluorodeoxyglucose is useful in detecting adenocarcinomas, sarcoma and some lymphomas, but it cannot specifically detect carcinoid tumours. Nuclear imaging and, particularly, octreotide scans using indium-111 octreotide, which binds to somatostatin receptors located in most carcinoid tumour cells, can facilitate the detection of a carcinoid tumour.2
Clinical and Nutritional Assessment in the Patient with Short Bowel Syndrome
Published in John K. DiBaise, Carol Rees Parrish, Jon S. Thompson, Short Bowel Syndrome Practical Approach to Management, 2017
Despite the importance of this information, it is often challenging to determine a patient’s remaining bowel anatomy, particularly when multiple surgeries have been performed (and in more than one institution no less!). There are a variety of ways to determine the remaining bowel anatomy. Ideally, operative reports will make note of how much of the bowel is remaining, the segment of bowel that was removed, and the apparent health of the remaining bowel. Unfortunately, it is more common for operative reports to note how much was resected, but not necessarily which bowel segment or the length that is remaining. If the operative reports are not available or lack this information, a barium contrast small bowel follow through (SBFT) can be ordered to estimate bowel length; an opisometer is a measuring instrument that can be used for this purpose. An SBFT also provides information regarding transit time and other structural information, including strictures and bowel dilatation [6]. A three-dimensional reconstructed abdominal computed tomography (CT) scan may also provide this information, presuming it was done since the patient’s last operation. CT enterography (CTE) combines a CT scan with large volumes of oral contrast to image the small bowel, is highly sensitive in evaluating small bowel disorders, and is increasingly being used to assess the small bowel because it is noninvasive and accurate. CTE has been shown to be more effective at detecting strictures than SBFT.
Gastrointestinal system
Published in David A Lisle, Imaging for Students, 2012
CT enterography consists of CT abdomen following ingestion of a large volume (1–1.5 litres) of dilute contrast material, e.g. combination of Gastrografin and methylcellulose. CT enterography is highly accurate for the diagnosis of bowel wall inflammation, and for the demonstration of complications such as sinus tracts, abscesses and strictures. The major limitation of CT enterography is the radiation dose; this is particularly relevant in young patients requiring repeated follow-up examinations.
Primary extranodal jejunal diffuse large B cell lymphoma as a diagnostic challenge for intractable emesis: a case report and review of literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Linda P Vien, Ashish Bains, Ho-Man Yeung
Repeat CT imaging, however, reported antral wall thickening, linitis plastic, and diffuse omental infiltration, which was concerning for gastric malignancy. Subsequent EGD did not show any esophageal or duodenal obstructions. Although extrinsic compression of the stomach was observed, there were no masses identified on imaging. Furthermore, both the stomach biopsy and cytological analysis of ascitic fluid did not reveal any malignant cells, which may have provided false reassurance. Persistent symptoms without any improvements prompted a CT enterography. CT enterography, compared to routine CT abdomen and pelvis, uses thinner sectioning and enteric contrast to display the small bowel in its entirety and includes assessment for entire bowel wall thickness along with surrounding mesenteric and perienteric fat. This ultimately revealed the jejunum as the site of obstruction.
Magnetic resonance enterography in Crohn’s disease patients: current state of the art and future perspectives
Published in Expert Review of Medical Devices, 2021
Hila Bufman, Rami Eliakim, Noam Tau, Michal Marianne Amitai
The most common imaging study performed is CT enterography (CTE). Its main advantages lie in the exam’s availability and cost. However, the use of CT include exposure to ionizing radiation, non-optimal when taking in to consideration the young age of the patients and the chronic nature of this disease, requiring repeat imaging studies and therefore may submit patients to increasing amounts of radiation [4].