No abstract available.
Intestinal Perforation* ; Leiomyoma* ; Osteomyelitis* ; Ultrasonography*

High-intensity focused ultrasound (HIFU) is a non-invasive uterine fibroid treatment option for patients who want to preserve fertility. However, according to several reports regarding ablation of solid tumors by HIFU, there are rare complications in patients with uterine leiomyomas, and overall data are still insufficient. Here, we report rare and major complications of HIFU, such as delayed intestinal perforation, uterine perforation with recto-uterine fistula, and osteomyelitis 29 days after the HIFU procedure to treat multiple myomas. Thus, we present a very serious case resulting from HIFU treatment of uterine fibroids and a review of the literature.
Fertility ; Fistula ; Humans ; Intestinal Perforation* ; Leiomyoma* ; Myoma ; Osteomyelitis* ; Ultrasonography* ; Uterine Perforation

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

The perforation and subsequent panperitonitis as one of the complications of a Meckel diverticulum is a rare complication, especially in infants. Complication of Meckel diverticulum, preoperative and operative patient's mean age is about 5 years old. A 13-month-old male infant presented at our emergency room with currant jelly stool of about 24 hours duration. Intussusception or bacterial enteritis was initially suspected. Gastrointestinal ultrasonography showed no evidence of intussusception or appendicitis. On the 3rd hospital day, he suddenly showed high fever and irritability. Abdominal CT suggested intraperitoneal and retroperitoneal abscess with air collection due to possible bowel perforation. The final diagnosis of perforation of Meckel diverticulum was made by laparoscopy and biopsy. We report a very rare case with perforation of Meckel diverticulum in infant period.
Abscess ; Appendicitis ; Biopsy ; Diagnosis ; Emergency Service, Hospital ; Enteritis ; Fever ; Humans ; Infant* ; Intestinal Perforation ; Intussusception ; Laparoscopy ; Male ; Meckel Diverticulum* ; Peritonitis ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVE: This study was aimed to study clinical characteristics of patients with intrauterine meconium peritonitis, differences of various factors in between those who required operation and those who did not, risk factors leading into operation, and prognosis in the era of high prenatal diagnosis. METHODS: A retrospective review of 53 patients was done. Various factors for operation group (n= 41) and non-operation group (control, n=12) were compared. The risk factors for operation were analyzed by logistic regression analysis. RESULTS: The mean gestational age and birth weight for 53 including 41 (77%) of prenatally diagnosed cases were 36+/-3.4 weeks and 2,819+/-755 g, respectively. The most frequent antenatal sonographic finding was calcification. The most common etiology was ileal atresia. The first and full feeding was at 1.4+/-1.5 and 4.2+/-1.9 day, respectively for control (11.3+/-10.9 and 32.3+/-24.7 day). Risk factors for operation included requirement of mechanical ventilation and cesarean delivery. Overall survival rate was 94%. Survivial rate of those who were antenatally diagnosed was 97.6% in comparison to 83.3% who were not. The growth at 12 months was satisfactory. CONCLUSION: Favorable outcome of intrauterine meconium peritonitis is reassuring and stems from multidisplinary team approach.
Birth Weight ; Gestational Age ; Humans ; Infant, Newborn ; Intestinal Perforation* ; Logistic Models ; Meconium* ; Peritonitis* ; Prenatal Diagnosis ; Prognosis ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Survival Rate ; Ultrasonography

Abdominal actinomycosis causing hydronephrosis in a patient with a ventriculoperitoneal shunt is very rare. A 27- year-old female patient was admitted complaining of lower abdominal pain. She had undergone ventriculoperitoneal shunt surgery 10 years ago. Abdominal Ultrasonography and a CT scan demonstrated an inflammatory mass in the lower left quadrant of the abdomen causing obstructive hydroureter and hydronephrosis. Laparotomy revealed a diffusely infiltrating mass involving the small bowel, mesentery, and sigmoid colon, and a 1cm perforation in the sigmoid colon. Actinomycosis was diagnosed upon histological examination. After treatment with antibiotics and surgery, the patient's condition improved.
Ventriculoperitoneal Shunt ; Ultrasonography ; Treatment Outcome ; Tomography, X-Ray Computed ; Intestinal Perforation/*diagnosis ; Inflammation ; Humans ; Female ; Colon, Sigmoid/*injuries/*pathology ; Adult ; Actinomycosis/*diagnosis ; Abdominal Pain

Compressed air can cause serious damage to internal organs. The stomach is an organ that is rarely perforated due to its elasticity. However, intestines are weaker and thinner compared to the stomach. A 40-year-old male came to the emergency room with severe abdominal pain due to dyspnea. The patient experienced abdominal pain right after his coworker shot compressed air into the patient's pants. The patient suffered from a rigid abdomen, and bed-side ultrasonography was carried out as soon as possible. Pneumoperitoneum was diagnosed by portable X-ray. After computed tomography, emergency paracentesis was carried out for decompression. After emergency paracentesis, the patient's symptoms and vital signs were stabilized. After the procedure, the patient had an emergency laparotomy.
Abdomen ; Abdominal Pain ; Adult ; Compressed Air* ; Decompression ; Dyspnea ; Elasticity ; Emergencies ; Emergency Service, Hospital ; Humans ; Intestinal Perforation ; Intestines ; Laparotomy ; Male ; Paracentesis ; Pneumoperitoneum* ; Stomach ; Ultrasonography ; Vital Signs

The risk of tuberculosis in renal transplant recipients may be related to immunosuppressive therapy, and it continues to complicate transplantation in the cyclosporine era. Extrapulmonary manifestation and dissemination also common clinical findings in the transplant recipients. Intestinal tuberculosis that develops with the involvement of other organs is common. We present a case of tuberculous intestinal perforation in the living-related donor renal transplant recipient. A 42-year-old male was admitted because of sudden onset acute abdomen. In April 1995, he received allograft kidney from HLA-identical sister following treatment with cyclosporine-A and low-dose steroids. Allograft function was stable over the next 36 months. About 3 years later, multiple cervical lymph node swelling was observed. Initial lymph node biopsy was performed, which showed granulomatous lesions with positive AFB stain. The patient was treated with antituberculous therapy regimen included isoniazid, ethambutol and rifampicin for a month. A ultrasonography and CT of the abdomen showed multiple adhesions in the peritoneum and enlargement of the mesenteric lymph nodes. A laparatomy finding was inflammatory thickening of the bowel wall in the terminal ileum with necrotic perforation. The involved terminal ileum was removed together with end-to-end anastomosis and peritoneal lavage was done. The patient was improved two weeks after surgical laparotomy.
Abdomen ; Abdomen, Acute ; Adult ; Allografts ; Biopsy ; Cyclosporine ; Ethambutol ; Humans ; Ileum ; Intestinal Perforation* ; Isoniazid ; Kidney ; Kidney Transplantation* ; Laparotomy ; Lymph Nodes ; Male ; Peritoneal Lavage ; Peritoneum ; Rifampin ; Siblings ; Steroids ; Tissue Donors ; Transplantation ; Tuberculosis ; Tuberculosis, Lymph Node ; Ultrasonography

PURPOSE: This study aimed to evaluate the clinical and radiologic findings suggestive of spontaneous intestinal perforation (SIP) in extremely-low-birth-weight infants (ELBWIs) with persistent gasless abdomen, and to investigate the usefulness of abdominal ultrasonography for the diagnosis of SIP. METHODS: In total, 22 infants with birth weights less than 1,000 g who showed persistent gasless abdomen on simple abdominal radiography were included. Perinatal, neonatal, and perioperative clinical findings were retrospectively reviewed, and the risk factors for intestinal perforation were evaluated. Abdominal sonographic findings suggestive of intestinal perforation were also identified, and postoperative short-term outcomes were evaluated. RESULTS: In total, eight of the 22 infants (36.4%) with gasless abdomen had SIP. The number of infants with patent ductus arteriosus who were treated with intravenous ibuprofen or indomethacin was significantly higher in the SIP group than in the non-SIP group (P<0.05). Greenish or red gastric residue, abdominal distension, or decreased bowel sound were more frequent in infants with SIP (P<0.05), in addition to gray or bluish discoloration of abdomen, suggestive of meconium peritonitis (P<0.05). Pneumoperitoneum on simple abdominal radiography was found in only one of the eight infants (12.5%) with SIP. Intramural echogenicity and echogenic extramural material on abdominal ultrasonography were exclusively observed in infants with SIP. Four infants (50%) with SIP died after surgical intervention. CONCLUSION: Intestinal perforation may occur in ELBWIs with gasless abdomen. As intramural echogenicity and extraluminal echogenic materials on abdominal ultrasonography are indicative of SIP, this technique could be useful for diagnosing SIP.
Abdomen ; Birth Weight ; Diagnosis ; Ductus Arteriosus, Patent ; Humans ; Ibuprofen ; Indomethacin ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Intestinal Perforation ; Meconium ; Peritonitis ; Pneumoperitoneum ; Radiography, Abdominal ; Retrospective Studies ; Risk Factors ; Ultrasonography

OBJECTIVETo improve the understanding of recognizing and diagnosis of neonatal necrotizing enterocolitis (NEC), imaging assessment of neonates with NEC was analyzed retrospectively.

METHODData of 211 cases of NEC were retrospectively collected from the Department of Neonatology, Children's Hospital of Chongqing Medical University between Jan.1(st) 2006-Dec.31(st) 2011.

RESULTAnalysis of abdominal X-ray of 211 cases showed that there were 40 cases (19.0%) who had no changes on each X-ray, 47 cases (22.3%) had improvement and 23 cases (10.9%) became worse. In the group of no changes, positive rate with good prognosis was 97.5% and with poor prognosis, it was 2.5%. In the group of improvement, positive rate with good prognosis was 97.9%, and the contrary was 2.1%. Positive rate with good prognosis was 56.5%, and the contrary was 43.5% in worse group. Chi-square analysis of the three groups showed χ(2) = 31.742, P < 0.01. Comparison of detection rate of pneumoperitoneum on abdominal X-ray (16.0%, 12/75) and Doppler US (1.3%, 1/75), χ(2) = 10.191, P < 0.05, portal pneumatosis on abdominal X-ray(1.3%, 1/75) versus Doppler US (12.0%,9/75), χ(2) = 6.857, P < 0.05. Surgical timing mostly corresponded to pneumoperitoneum (OR = 19.543) and intestinal obstruction (OR = 19.527) of abdominal X-ray. The logistic regression equation is y = -2.915-1.588x1+2.972x4+2.973x7 + 1.711x9 (χ(2) = 101.705, P < 0.01).

CONCLUSIONAbdominal X-ray is the most important method of diagnosis of NEC, the group of deterioration of abdominal X-ray has obvious bad prognosis differ from no change group and better group. Comparison with abdominal X-ray and Doppler US, the former in pneumoperitoneum positive rate was higher than the latter, at the same time, portal pneumatosis on Doppler US is more sensitive to abdominal X-ray, the value of two imaging assessments both supplement each other. Surgical timing mostly corresponds to pneumoperitoneum and intestinal obstruction.

Abdomen ; diagnostic imaging ; surgery ; Birth Weight ; Enterocolitis, Necrotizing ; diagnosis ; pathology ; surgery ; Female ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnosis ; pathology ; surgery ; Infant, Premature ; Intestinal Perforation ; diagnostic imaging ; surgery ; Logistic Models ; Male ; Pneumoperitoneum ; diagnosis ; diagnostic imaging ; Portal Vein ; diagnostic imaging ; pathology ; Predictive Value of Tests ; Prognosis ; Radiography, Abdominal ; Retrospective Studies ; Severity of Illness Index ; Ultrasonography, Doppler, Color