With recent technical advances, increasing use of sonography in the initial evaluation of patients with abdominal disease may allow the detection of unexpected tumor within the abdominal cavity. Easiness of sonographic detection of bowel pathology, purposely or unexpectedly, warrants the inclusion of bowel loops during ultrasound examination when a patient complains of symptoms indicating diseases of the bowel. In patients complaining of acute abdominal symptoms or nonspecific gastrointestinal symptoms and showing signs such as abdominal pain, diarrhea, hematochezia, change of bowel habit, or bowel obstruction, sonography may reveal the primary causes and may play a definitive role in making a diagnosis. On ultrasonography, abnormal lesions may appear as fungating mass with eccentrically located bowel lumen (pseudokidney sign) or symmetrical or asymmetrical, encircling thickening of the colonic wall (target sign). In patients with mass or wall thickening detected on ultrasonography, additional work-up such as barium study, CT or endoscopy would be occasionally necessary for making a specific diagnosis.
Abdomen, Acute/ultrasonography ; Aged ; Appendicitis/ultrasonography ; Colorectal Neoplasms/ultrasonography ; Diverticulitis/ultrasonography ; Female ; Gastrointestinal Diseases/ultrasonography+ACo- ; Gastrointestinal Neoplasms/ultrasonography ; Human ; Inflammatory Bowel Diseases/ultrasonography ; Intestinal Obstruction/ultrasonography ; Intestinal Perforation/ultrasonography ; Intestines/ultrasonography ; Male ; Stomach/ultrasonography ; Ultrasonography/instrumentation

Although solitary rectal ulcer syndrome (SRUS) has a characteristic pathologic findings on biopsy specimen, the diagnosis of which often is delayed because this syndrome is easily mistaken for rectal cancer, inflammatory bowel diseases or other forms of proctitis. The mucosal prolapse syndrome has been widely accepted because presence of rectal ulcer is multiple or absent, and this syndrome include related disorder like as colitis cystica profunda. Proctosigmoidoscopy can show variable lesion to differentiate SRUS, which has abnormal gross findings from ulcerative lesions to polypoid lesion, mild proctitis, thickened nodular folds. Endoscopic transrectal ultrasonography (ETUS) has been known to useful procedure to staging and follow up of anorectal carcinoma. ETUS could clearly delineate the rectal wall and its separate layers, and mucosal ulcers or changes in the rectal wall architecture. A 49-year-old female complained of rectal bleeding, mucoid stool and excessive straining with rectal pain. Proctosigmoidoscopic finding revealed irregular rectal ulcers mimicking malignancy. SRUS was diagnosed based on clinical symptom, rectal biopsy and ETUS.
Biopsy ; Colitis ; Diagnosis ; Endosonography ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Middle Aged ; Proctitis ; Prolapse ; Rectal Neoplasms ; Sigmoidoscopy ; Ulcer* ; Ultrasonography

Portal vein thrombosis (PVT) is an uncommon cause of presinusoidal hypertension and can result from cirrhosis, malignancy, infection, inflammation, and congenital and acquired thrombophilic states. Infectious and inflammatory causes include pylephlebitis, omphalitis, diverticulitis, pancreatitis, cholecystitis, appendicitis, and inflammatory bowel disease. However, PVT induced by a lung abscess has not been reported. We experienced a 50-year-old male complaining of right upper quadrant pain, fever, and coughing. A lung abscess and PVT were revealed by computed tomography and abdominal Doppler ultrasonography. The PVT resolved, in part, after an 8-day course of antibiotic therapy. We report a case of PVT as a complication of a lung abscess and review the literature.
Appendicitis ; Cholecystitis ; Cough ; Diverticulitis ; Fever ; Fibrosis ; Humans ; Hypertension ; Inflammation ; Inflammatory Bowel Diseases ; Lung ; Lung Abscess ; Male ; Middle Aged ; Pancreatitis ; Portal Vein ; Protein S ; Thrombosis ; Ultrasonography, Doppler

Characterizing inflammation and fibrosis in Crohn's disease (CD) is necessary to guide clinical management, but distinguishing the two remains challenging. Novel ultrasound (US) techniques: contrast-enhanced US (CEUS) and shear wave elastography (SWE) offer great potential in evaluating disease activity in pediatric patients. Three patients ages 16 to 20 with known CD underwent CEUS and SWE to characterize bowel wall inflammation and fibrosis. Magnetic resonance enterography, endoscopy, or surgical pathology findings are also described when available. The patients' disease activity included acute inflammation, chronic inflammation with stricture formation, and a fibrotic surgical anastomosis without inflammation. CEUS was useful in determining the degree of inflammation, and SWE identified bowel wall fibrosis. Used together these techniques allow for better characterization of the degree of fibrosis and inflammation in bowel strictures. With further validation CEUS and SWE may allow for improved characterization of bowel strictures and disease flares in pediatric patients suffering from CD.
Adolescent ; Anastomosis, Surgical ; Constriction, Pathologic ; Contrast Media ; Crohn Disease ; Elasticity Imaging Techniques ; Endoscopy ; Fibrosis ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Pathology, Surgical ; Pediatrics ; Ultrasonography

Thirteen women with rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy were operated on during Jan. 1993 - Jul. 1997 at Song-Do Colorectal Hospital. The mean age was 36.9 (range, 25~56) years. The mean follow-up after operation was 33 (range, 8~62) months. The etiology of the fistula in the majority of patients was obstetric injury and operative trauma (10/13). Seven patients were referred after attempts at repair elsewhere. Eleven patients were managed with a mucosal flap advancement and a 3-layered repair of the rectovaginal septum: 4 without and 7 with a perineal body reconstruction or sphincter repair. Two patients were managed with a mucosal flap advancement only without a repair of rectovaginal septum. In all cases, a concomitant colostomy was not performed. Postoperative complications were noticed in 3 of the patients managed by a mucosal flap advancement and 3-layered repair of the rectovaginal septum with perineal body reconstruction or sphincter repair and all were perineal wound infections. All of these infections were cured, without recurrence, by simple rubber seton drainage. Recurrence occurred in one case managed by a mucosal flap advancement only. Three patients with liquid incontinence became continent after a sphincter reconstruction. We conclude that most rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy can be managed with a mucosal flap advancement and 3-layered reconstruction of the rectovaginal septum. If any signs or symptoms of sphincter injury are noticed preoperatively while taking the patient's history or during manometry and endorectal ultrasonography, a perineal body reconstruction or sphincter repair should be performed.
Colostomy ; Drainage ; Female ; Fistula ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases ; Manometry ; Postoperative Complications ; Radiotherapy ; Rectovaginal Fistula* ; Recurrence ; Rubber ; Ultrasonography ; Wound Infection

BACKGROUND/AIMS: Mesenteric microvascular thrombosis has been implicated as a contributing factor to the pathogenesis of inflammatory bowel disease (IBD). The aim of the current study was to assess the possibility of subclinical atherosclerosis in patients with IBD by measuring their carotid intima-media thickness (c-IMT). METHODS: Thirty-eight patients with IBD who were followed-up for at least 3 years participated. Patients with a history of cardiovascular disease and known risk factors for atherosclerosis were excluded. As a control group, 38 healthy patients matched for age and gender without atherosclerosis risk factors were included. Carotid ultrasonography was performed in all patients and controls. Patient baseline characteristics and laboratory parameters were recorded to evaluate atherosclerosis risk factors. RESULTS: The mean age of patients with IBD was 38.5+/-6.62 years. Twenty-three patients with IBD were diagnosed with ulcerative colitis and the other 15 cases were diagnosed with Crohn's disease. The median duration of disease was 52.0 months. Serologic markers such as erythrocyte sedimentation rate, C-reactive protein (CRP), and cholesterol levels differed significantly, however, there was no significant difference in c-IMT between patients with IBD and those in the control group (0.53+/-0.10 mm vs. 0.53+/-0.07; P=0.85). Multivariate analysis revealed that body mass index, CRP, disease duration, and age were significantly correlated with c-IMT in patients with IBD. CONCLUSIONS: The results of the current study did not show an increase in c-IMT in patients with IBD. Further studies that include more subjects and a longer follow-up period will be necessary in order to evaluate the risk of atherosclerosis in Korean patients with IBD.
Atherosclerosis ; Blood Sedimentation ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Carotid Intima-Media Thickness* ; Cholesterol ; Colitis, Ulcerative ; Crohn Disease ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases* ; Multivariate Analysis ; Risk Factors ; Thrombosis ; Ultrasonography

Patients with inflammatory bowel disease are known to have hypercoagulability and an increased risk for venous thromboembolism. The deep veins of the lower extremities and the pulmonary veins are the most common sites of thrombosis in ulcerative colitis. However, hepatic vein thrombosis (Budd-Chiari syndrome) is a very rare extra-intestinal complication of ulcerative colitis in children. We describe a case of hepatic vein thrombosis in a 15-year-old girl with ulcerative colitis who presented with abdominal pain and hematochezia. Doppler ultrasonography and an abdominal CT scan revealed the characteristic filling defects caused by large thrombi in both hepatic veins. These lesions were successfully treated with conventional management for ulcerative colitis and anticoagulation therapy.
Abdominal Pain ; Adolescent ; Budd-Chiari Syndrome ; Child ; Colitis, Ulcerative ; Gastrointestinal Hemorrhage ; Hepatic Veins ; Humans ; Inflammatory Bowel Diseases ; Lower Extremity ; Pulmonary Veins ; Thrombophilia ; Thrombosis ; Ulcer ; Ultrasonography, Doppler ; Veins ; Venous Thromboembolism

PURPOSE: To evaluate the radiologic findings of alimentary anthrax. MATERIALS AND METHODS: 19 patients with alimentary anthrax, which was caused by ingestion of contaminated beef, were included in this study. The diagnosis was made .b.y demonstration of Bacillus anthracis in smear and culture of the contaminated meat. We evaluated the clinical manifestations and the findings of thoracic, abdominal radiographs, cervical, abdominal ultrasonograms and abdominal CT scans. RESULTS: Out of the 19 patients with the alimentary infection, 9 had oropharyngeal form, 18 had abdominal form and 8 had combination of oropharyngeal and abdominal form. The patients had general symptoms and signs such as fever, chill, myalgia. Clinical symptoms and signs were sore throat, throat injection, throat ulcer and patch in oropharyngeal form, and nausea, vomiting, abdominal pain, diarrhea, and gross GI bleeding in abdominal form. Radiologic findings included enlarged cervical lymph nodes(36%) in oropharyngeal form, and paralytic ileus(26%), ascites(26%), hepatomegaly(21%), enlarged mesenteric lymph nodes(26%), small bowel wall thickening(5%) in abdominal form. In two patients, late complications occurred as intestinal obstruction due to ileal stricture with perforation, and inflammatory changes of pelvic cavity due to ileovesical fistula. CONCLUSION: Radiologic findings of alimentary anthrax are difficult in differentiation from those of other inflammatory bowel disease, but those radiologic findings with clinical manifestations may be helpful in diagnosis and evaluation of disease process in patients with alimentary anthrax.
Abdominal Pain ; Anthrax* ; Bacillus anthracis ; Constriction, Pathologic ; Diagnosis ; Diarrhea ; Eating ; Fever ; Fistula ; Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Intestinal Obstruction ; Meat ; Myalgia ; Nausea ; Pharyngitis ; Pharynx ; Tomography, X-Ray Computed ; Ulcer ; Ultrasonography ; Vomiting