PURPOSE: To compare the accuracy of computed tomography (CT) and ultrasound (US) in the diagnosis of bezoars in small bowel obstruction. MATERIALS AND METHODS: During a recent eight-year period, 23 patients underwent surgery due to small bowel obstruction caused by bezoars, and 14 who underwent both CT and US were included in this study. The scans obtained were retrospectively reviewed by two radiologists working independently, and the usefulness of each modality in terms of diagnostic capacity, determination of the level of obstruction and detection of additional bezoars was assessed. RESULTS: At surgery, a total of 22 bezoars were removed: 19 from the small intestine and three from the stomach; multiple bezoars were found in five of the 14 patients. The presence of bezoars was demonstrated by CT in all patients, and by US in ten (71%) (p=0.125). The level of obstruction was correctly predicted in 57% of cases at US and in 100% at CT (p=0.03). Overall sensitivity was 55% for US (12/22) and 96% for CT (21/22) (p<0.01). In three patients with associated gastric bezoars, US revealed only one, whereas all were demonstrated by CT. In five with multiple lesions, only five (39%) of 13 were apparent at US, but 12 (92%) were revealed by CT. CONCLUSION: Both US and CT were useful for the diagnosis of small bowel obstruction caused by bezoars. CT however, was more accurate in determining the level of obstruction and in revealing additional bezoars in the small bowel and stomach.
Bezoars* ; Diagnosis ; Humans ; Intestine, Small ; Retrospective Studies ; Stomach ; Ultrasonography

Polypoid or tumorous arteriovenous malformation (AVM) of small intestine is rare and can be misdiagnosed as other tumorous conditions. We experienced a rare case of giant jejunal AVM in a 15-year-old boy, who complained of intense abdominal pain. Ultrasonography and contrast-enhanced CT revealed a 13.5-cm-sized multiseptated cystic mass arising in small intestine, which was mimicking submucosal tumor. It was successfully treated by surgical resection. The specimen showed a multilobulated outbulging submucosal mass in jejunum. Histopathologic evalulation confirmed AVM located in the submucosa, muscularis propria and subserosa. This case is the largest AVM of small intestine among which has ever been reported.
Abdominal Pain ; Adolescent ; Arteriovenous Malformations* ; Humans ; Intestine, Small ; Jejunum* ; Male ; Tomography, X-Ray Computed ; Ultrasonography

Inflammatory fibroid polyp is a relatively rare, benign polyp which is composed of fibraus connective tissue, blood vessels, and infiltration of eosinophils. The majority of inflammatory fibroid polyps has been reported with pathologic specimen in stomach and small intestine. We performed the gastrofiberscopy and endoscopic ultrasonogram of an inflammatory fibroid polyp, which reveals central ulcerated polypoid mass originated in the submucosa of antral portion of the stomach. So we report a case of endoscopic and endoscopic ultrasonographic findings of inflammatory fibroid piolyp in stomach. The etiolagy and pathology are discussed with the review of the literatures.
Blood Vessels ; Connective Tissue ; Eosinophils ; Intestine, Small ; Leiomyoma* ; Pathology ; Polyps* ; Stomach* ; Ulcer ; Ultrasonography

The objectives of this study were to observe normal peristalsis and mixing (or segmental movements) and to evaluate an acupuncture stimulation (ST-36 and BL-27) on the intestinal (duodenum) motility in normal dogs using duplex Doppler sonography. Fifteen healthy Beagle dogs were used for this experiment after the administration of warm saline and pellet feeding. The duodenal motility was examined using duplex Doppler sonography. Six hours after the pellet feeding, an electroacupuncture stimulation at ST-36 and BL-27 was applied and the duodenal motility was examined using duplex Doppler sonography pre-stimulation, during the stimulation and post-stimulation. After saline and pellet administration, the duplex Doppler sonograms showed 3 types of peristalsis and a mixing type (or segmental movement) of duodenum motility. In the peristalsis types, most yielded high-amplitude signals which had one high peak (type-1), two high peaks (type-2), and three high peaks (type-3) and lasted more than 1.3 seconds. Mixing type of duodenum motility had weak signals and were lasted more than 1.5 seconds. Among the peristalsis types, the type 1 and type 2 were predominant and the type 3 was rarely observed. The frequency of intestinal motility stimulated by ST-36 acupoint was increased during the acupuncture stimulation (20% increase compared to the basal value) and decreased (7% decrease compared to the basal value) after stimulation. The frequency of intestinal motility stimulated by BL-27 acupoint was decreased during the acupuncture stimulation (31% decrease compared to the basal value) and increased (18% increase compared to the basal value) after stimulation. There was a significant increase(p<0.01) between the value found in during and the post-stimulation tests. We conclude that duplex Doppler studies permit a graphic visualization of intestinal movements which can be qualitatively and quantitatively analyzed using this technique, it is possible to evaluate the gastrointestinal motility after an acupuncture stimulation.
Acupuncture Points ; Animals ; Dogs/*physiology ; Electroacupuncture/methods/*veterinary ; *Gastrointestinal Motility ; Intestine, Small/physiology/*ultrasonography ; Peristalsis ; Ultrasonography, Doppler, Duplex/methods/*veterinary

Femoral hernias account for up to 4% of all hernias that occur in the inguinal region. The hernial sac usually contains the greater omentum, small intestine, large intestine and preperitoneal fat, but rarely, in only 0.8% of the all cases, it also contains the appendix. Femoral, inguinal and incisional hernias, combined with appendicitis, occur in only 0.13% of cases. Thus, the incidence of appendicitis associated with a femoral hernia would be expected to be very rare. Herein, a case of an incarcerated femoral hernia, including a gangrenous appendix, is reported. An 81-year-old female was admitted with a protruding mass in the right inguinal area of 2 days duration. On inspection, a 4x3 cm sized erythematous bulging mass was noted. On palpation, the mass was tender and fixed in nature. There were no signs of peritoneal irritation or other palpable masses in the whole abdomen. Under the impression of a femoral hernia, a manual reduction was attempted, but to no avail. An immotile edematous intestine was noted on ultrasonography, and fluid retention with decreased blood circulation was noted in the intestine, suggestive of incarceration. An emergency operation was performed, with an incision made through the right groin region, where an incarcerated femoral hernia, including a gangrenous appendix, was found. An appendectomy and McVay repair were performed. The patient was discharged after 5 days, without any complications.
Abdomen ; Aged, 80 and over ; Appendectomy ; Appendicitis ; Appendix* ; Blood Circulation ; Emergencies ; Female ; Groin ; Hernia ; Hernia, Femoral* ; Humans ; Incidence ; Intestine, Large ; Intestine, Small ; Intestines ; Omentum ; Palpation ; Ultrasonography

OBJECTIVE: To describe the sonographic (US) and clinical features of spontaneously reduced small bowel intussusception, and to discuss the management options for small bowel intussusception based on US findings with clinical correlation. MATERIALS AND METHODS: During a five years of period, 34 small bowel intussusceptions were diagnosed on US in 32 infants and children. The clinical presentations and imaging findings of the patients were reviewed. RESULTS: The clinical presentations included abdominal pain or irritability (n = 25), vomiting (n = 5), diarrhea (n = 3), bloody stool (n = 1), and abdominal distension (n = 1), in combination or alone. US showed multi-layered round masses of small (mean, 1.5+/-0.3 cm) diameters and with thin (mean, 3.5+/-1 mm) outer rims along the course of the small bowel. The mean length was 1.8+/-0.5 cm and peristalsis was seen on the video records. There were no visible lead points. The vascular flow signal appeared on color Doppler images in all 21 patients examined. Spontaneous reduction was confirmed by combinations of US (n = 28), small bowel series (n = 6), CT scan (n = 3), and surgical exploration (n = 2). All patients discharged with improved condition. CONCLUSION: Typical US findings of the transient small bowel intussusception included 1) small size without wall swelling, 2) short segment, 3) preserved wall motion, and 4) absence of the lead point. Conservative management with US monitoring rather than an immediate operation is recommended for those patient with typical transient small bowel intussusceptions. Atypical US findings or clinical deterioration of the patient with persistent intussusception warrant surgical exploration.
Abdomen/physiopathology ; Abdominal Pain/etiology ; Child ; Child, Preschool ; Diarrhea/etiology ; Female ; Humans ; Infant ; Intestine, Small/*ultrasonography ; Intussusception/*ultrasonography ; Irritable Mood ; Male ; Occult Blood ; Ultrasonography, Doppler, Color ; Vomiting/etiology

We report a case in which mucinous adenocarcinoma arose in a duplication cyst at the distal ileum with in-traperitoneal seeding. A thirty-three-year-old male patient presented with abdominal distension. Ultrasonography, CT and MR imaging revealed a dumbbell-shaped cystic mass adherent to the small intestine. The wall of the mass was thickened in two areas and contained inhomogeneous materials. A large amount of ascites with irregular masses along the greater omentum were seen present. Surgery revealed a duplication cyst adherent to the ileum. Pathologic examination proved that the thickened portions of the wall of the mass were mucinous adenocarcinoma, and that the nodules on the greater omentum were metastatic adenocarcinoma.
Adenocarcinoma* ; Adenocarcinoma, Mucinous ; Ascites ; Humans ; Ileum ; Intestinal Neoplasms ; Intestine, Small ; Intestines ; Magnetic Resonance Imaging ; Male ; Omentum ; Ultrasonography

To evaluate the ultrasound imaging characteristics and diagnostic criteria for acute abdominal Meckel's di- verticulum disease (MD), we retrospectively analyzed the ultrasonic characteristics, clinical data of 58 cases of pathologically proved MD from January 2009 to May 2012. We found that among all the 58 patients, 21 patients were diagnosed with the preoperative clinical diagnosis of MD. Fourteen cases of MD inflammation with acute appendicitis were evaluated by pathological examinations after the surgery. We also found 4 cases of MD with perforation, 15 cases of MD with intussusceptions, 14 cases MD with intestinal obstruction, 5 cases of MD secondary to intestinal obstructionor intestinal necrosis, and 5 cases of MD without any obvious complications. Emergency ultrasound examinations revealed 8 cases of simple MD, 1 case of MD with intussusceptions, 9 cases of MD with acute appendicitis, 12 cases of MD with intestinal obstruction, 2 cases of MD with intussusceptions and intestinal obstruction, 1 case of MD with omphalocele and 1 case of MD with abdominal abscess. The emergency sonographic findings suggested that MD was relatively fixed bowel or thick-walled cystic mass, with one end connected to small intestine, and the other end connected to the blind side, at the periumbilicus region or at the lower right abdomen. A conclusion could be drawn that MD is difficult to be detected by ultrasound (detection rate was about 15. 5%), and MD with complications such as intussusceptions, intestinal obstruction, acute appendicitis can usually be more easily detected (detection rates were 24.1%, 24.1% and 15.5%, respectively). Sonography is a simple, effective way to make diagnosis and differential diagnosis of MD with different acute abdomen symptoms from other disease.
Acute Disease ; Appendicitis ; pathology ; Diagnosis, Differential ; Humans ; Inflammation ; Intestine, Small ; pathology ; surgery ; Meckel Diverticulum ; diagnostic imaging ; surgery ; Retrospective Studies ; Ultrasonography

PURPOSE: To evaluate ultrasonographic accuracy in the differentiation of a bezoar from feces in a small bowel obstruction showing feces-like material just proximal to the transitional zone in abdominal computed tomography (CT). METHODS: This study included 14 patients who showed feces-like material just proximal to the transitional zone, among 302 patients diagnosed with small bowel obstruction on abdominal CT. The diagnostic signs of a bezoar on ultrasonography included an arc-like surfaced intraluminal mass, posterior acoustic shadow and twinkling artifacts. The diagnostic performance of ultrasonography in each patient was compared with a final diagnosis that was surgically or clinically made. RESULTS: Among the 14 patients, seven were ultrasonographically diagnosed as having a bezoar, and five of the seven were surgically diagnosed as having a phytobezoar. The remaining two of the seven showed complete symptomatic improvement before surgery. The other seven patients were ultrasonographically diagnosed as not having a bezoar. Among them, six patients were conservatively treated with symptomatic improvement, suggesting the absence of a bezoar. The remaining one patient was confirmed not to have a bezoar during adhesiolysis. In all patients, the ultrasonographic diagnosis agreed with the clinically confirmed diagnosis. CONCLUSION: Ultrasonography might be an accurate method for the differential diagnosis of feces-like material just proximal to the transitional zone in abdominal CT. It can help radiologists to quickly and easily diagnose a bezoar.
Acoustics ; Artifacts ; Bezoars* ; Diagnosis ; Diagnosis, Differential ; Feces* ; Humans ; Intestinal Obstruction ; Intestine, Small ; Tomography, X-Ray Computed ; Ultrasonography

Follicular lymphoma is the most common form of low-grade B cell lymphoma. Follicular lymphoma occurs predominantly at lymph node sites and rarely in the gastrointestinal tract. Rare gastrointestinal follicular lymphoma is most commonly found in the small intestine, especially in the duodenum, and appears as multiple granules. However, gastric follicular lymphoma mostly appears as a subepithelial tumor. We observed two primary gastric follicular lymphomas that resembled subepithelial tumors located in the body of the stomach. Endoscopic ultrasound revealed hypoechoic lesions located in the submucosa layer. Since endoscopic forceps biopsies were inconclusive, we performed endoscopic submucosal dissection, which resulted in a final pathologic diagnosis of follicular lymphoma. Because of the indolent nature of gastrointestinal follicular lymphoma, the “watch and wait” strategy can be applied in the early phase. The identification of endoscopic characteristics of gastric follicular lymphoma can be helpful for differential diagnosis and decision of treatment strategy. Therefore, we report two cases of primary gastrointestinal follicular lymphoma diagnosed following endoscopic submucosal dissection.
Biopsy ; Diagnosis ; Diagnosis, Differential ; Duodenum ; Gastrointestinal Tract ; Intestine, Small ; Lymph Nodes ; Lymphoma, B-Cell ; Lymphoma, Follicular ; Stomach ; Surgical Instruments ; Ultrasonography