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Duodenal atresia and stenosis
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Afif N. Kulaylat, Colin G. DeLong, Simon Clarke, Robert E. Cilley
Duodenal obstruction may be diagnosed prenatally by fetal ultrasound or fetal magnetic resonance imaging (MRI). A dilated stomach and duodenum are seen on imaging studies. Neonates with congenital duodenal obstruction most often present with obvious symptoms on the first day of life. Feeding intolerance and vomiting, which is usually bilious, are noted from the outset. Vomiting may be non-bilious when preampullary obstruction is present. Dehydration and electrolyte depletion rapidly ensue if the condition is not recognized and IV therapy begun. Parenteral nutrition is frequently initiated as feeding is often delayed after repair. Secondary complications, such as aspiration and respiratory failure, may also be present. The presence of a “double bubble” on a plain abdominal radiograph is essentially diagnostic of duodenal atresia. Air may be seen distally in the gastrointestinal tract with incomplete obstructions (e.g. stenosis) or an unusual double ampulla that opens both above and below the stenosis. Contrast radiography is confirmatory and may be especially helpful in confirming the diagnosis. Differentiating intrinsic duodenal obstruction from malrotation with volvulus is also facilitated with contrast radiography. Duodenal obstruction is treated less urgently than malrotation by some surgeons and therefore differentiating between the two entities is critical. Assuming that the diagnosis of malrotation with midgut volvulus has been excluded, workup and evaluation of other potential associated anomalies may proceed.
Acute Presentation (Boerhaave’s Syndrome)
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Water-soluble oral contrast radiography has been superseded by CT since the logistics of their performance are frequently limited in patients who are in shock. However, their dynamic nature gives information about the degree of containment and the degree of drainage of the perforation. They also remain useful post-treatment to assess progress of healing.
Benign obstruction of the colon
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Indications for contrast radiography in suspected acute small bowel obstruction remain controversial [7]. In stable patients in whom the diagnosis is uncertain, or in those who are considered high surgical risks, a contrast study is useful to confirm the diagnosis and determine the site and severity of the obstruction. In the postoperative patient, for example, it will help in distinguishing obstruction from paralytic ileus. The most definitive studies are obtained by small bowel enema, infusing barium through a tube placed past the ligament of Treitz under fluoroscopic guidance (Fig. 14.3). Small bowel mucosal abnormalities, intraluminal masses and points of obstruction may be identified in a highly accurate way. Passage of barium through an area of partial obstruction within 24 hours in a stable patient whose proximal bowel does not appear compromised suggests that a careful trial of intestinal decompression is safe. In contrast, evidence for a high-grade obstruction with thickened, dilated proximal bowel, mucosal disruption, or findings of a closed loop should prompt urgent surgical treatment. Contrast radiography is more commonly employed in large bowel obstruction, where a barium enema also has therapeutic potential (e.g. intussusception or volvulus). Other imaging modalities include ultrasound [8], computed tomography [9] and magnetic resonance imaging. These may be helpful in identifying abdominal wall hernias, fluid-filled loops of bowel, and intraluminal or extraluminal masses.
External validation and comparison of simple ultrasound activity score and international bowel ultrasound segmental activity score for Crohn’s disease
Published in Scandinavian Journal of Gastroenterology, 2023
Lu Wang, Chenjing Xu, Yanyan Zhang, Wenyu Jiang, Jingjing Ma, Hongjie Zhang
For over 20 years, various US scoring systems for evaluating disease activity in CD have been proposed [15–20]. The most commonly used parameters included BWT, CDS, BWS, fat wrapping, and contrast enhancement. Futagami et al. applied the BWT and BWS parameters to develop the US score [19]. The gold standard is not uniform because patients receive either barium contrast radiography or endoscopy. Drew et al. [20] retrospectively analyzed histological inflammation and Limberg score of ileum biopsies obtained by ileocolonoscopy in 32 patients, and the correlation was poor (K = 0.66; sensitivity 95%; 69% specificity). Sasaki et al. [21] directly compared the SES-CD score with the Limberg score in the ileum, and the correlation was good (r = 0.709, p < 0.001). Pascu et al. [22] created an index with BWT, CDS, compressibility, BWS, and fat wrapping as parameters using an endoscopic modified Baron score as a reference in 37 patients with CD. Overall, a good correlation between US and ileocolonoscopy was identified (r = 0.830, p < 0.001). Jing et al. [17] created a multi-parametric regression model using seven factors from four modes of US to predict the activity of CD, including BWT, mesenteric fat thickness, BWS, Limberg grade, the texture of enhancement, bowel wall perforation, and peristalsis. Nevertheless, an endoscopic score was not used as a reference and it lacks validation. In 2017, Novak et al. [15] developed and validated a US scoring system with BWT and CDS as parameters, and AUC was 0.865. However, a retrospective study of patients with ulcerative colitis at the development stage indicated heterogeneity. SES-CD or Rutgeerts score was used as the endoscopic scoring system in the validation phase. The sonologists and endoscopists were not blinded to each other’s examinations.