CT enterography and magnetic resonance (MR) enterography are widely used imaging modalities used to examine the small bowel. These radiologic tests are distinguished from routine abdominopelvic CT and MRI by the oral ingestion of a large amount of neutral contrast to distend the small bowel before scanning. For achievement of high quality, diagnostic images and proper technique are required. Conducted protocols still vary in patient preparation, enteric contrast, and CT and MRI acquisition sequences, resulting in heterogeneous diagnostic accuracy. The purpose of this article is to review the processes and techniques that optimize CT/MR enterography for patients with suspected Crohn's disease or other small bowel diseases.
Crohn Disease ; Diagnostic Imaging ; Eating ; Humans ; Intestine, Small ; Magnetic Resonance Imaging ; Multidetector Computed Tomography

BackgroundThe diagnosis and treatment of small-bowel diseases is clinically difficult. The purpose of this study was to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy in small-bowel diseases.

MethodsThe history and outcomes of 2806 patients who underwent double-balloon enteroscopy from July 2004 to April 2017 were reviewed, which included 562 patients with obscure digestive tract bleeding, 457 patients with obscure diarrhea, 930 patients with obscure abdominal pain, 795 patients with obscure weight loss, and 62 patients with obscure intestinal obstruction. Examinations were performed through the mouth and/or anus according to the clinical symptoms and abdominal images. If a lesion was not detected through one direction, examination through the other direction was performed as necessary. Eighty-four patients with small-bowel polyps, 26 with intestinal obstruction caused by enterolith, and 18 with bleeding from Dieulafoy's lesions in the small intestine were treated endoscopically.

ResultsA total of 2806 patients underwent double-balloon enteroscopy, and no serious complications occurred. An endoscopic approach through both the mouth and anus was used in 212 patients. Lesions were detected in 1696 patients, with a detection rate of 60.4%; the rates for obscure digestive tract bleeding, diarrhea, abdominal pain, weight loss, and intestinal obstruction were 85.9% (483/562), 73.5% (336/457), 48.2% (448/930), 49.1% (390/795), and 62.9% (39/62), respectively. For patients with small-bowel polyps who underwent endoscopic therapy, no complications such as digestive tract bleeding and perforation occurred. Intestinal obstruction with enteroliths was relieved with endoscopic lithotripsy. Among the 18 patients with bleeding from small-bowel Dieulafoy's lesions, 14 patients were controlled with endoscopic hemostasis.

ConclusionDouble-balloon enteroscopy is useful for diagnosing and treating some small-bowel disease.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Double-Balloon Enteroscopy ; methods ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; surgery ; Humans ; Intestinal Diseases ; diagnosis ; surgery ; Intestinal Obstruction ; Intestine, Small ; diagnostic imaging ; Leiomyosarcoma ; diagnosis ; surgery ; Lymphoma ; diagnosis ; surgery ; Male ; Middle Aged ; Polyps ; diagnosis ; surgery ; Young Adult

Primary malignant small bowel tumor as a rare kind of intestinal tumor is associated with a poor prognosis. The pathological types were various and complicated, such as adenocarcinoma, neuroendocrine tumor, malignant lymphoma, and malignant stromal tumor. The atypical early stage symptom resulted in difficult diagnosis at early stage, high misdiagnosis rate and lack of standard therapy schemes and means. In the past, X-ray, CT, MRI, and PET-CT were the main examination methods for primary small bowel tumor. However, with the development of radiology, a series of new diagnosis methods, including electronic enteroscopy, capsule endoscopy, multi-slice spiral CT enteroclysis and so on, promotes the diagnosis accurate rate. Surgery is still the most important method in the small bowel tumor treatment, and the alternative of the surgical method should depend on the tumor location, size and relationship with the adjacent organs. Application of the laparoscopic surgery for the small bowel tumor is still in the initial stage. Besides, some researches have confirmed that chemotherapy, radiotherapy, target therapy and endocrinotherapy have effects on the specific kind of small bowel tumor. Therefore this article will review the epidemiology, pathology, diagnosis and treatment of the primary malignant small bowel tumors.
Adenocarcinoma ; diagnosis ; epidemiology ; pathology ; therapy ; Capsule Endoscopy ; Gastrointestinal Stromal Tumors ; diagnosis ; epidemiology ; pathology ; therapy ; Humans ; Intestinal Neoplasms ; diagnosis ; epidemiology ; pathology ; therapy ; Intestine, Small ; diagnostic imaging ; pathology ; Laparoscopy ; methods ; Lymphoma ; diagnosis ; epidemiology ; pathology ; therapy ; Neuroendocrine Tumors ; diagnosis ; epidemiology ; pathology ; therapy ; Tomography, Spiral Computed

OBJECTIVETo evaluate the diagnostic value of preoperative CT enterography (CTE) on obstruction, fistula and abscess formation compared to intraoperative findings in patients undergoing surgery for Crohn's disease(CD), aiming to provide reference to clinical practice.

METHODSPreoperative CTE data of 176 CD patients confirmed by clinic, endoscopy, imaging, operation and pathology at the Department of General Surgery in Nanjing Jinling Hospital from January 2013 to December 2015 were enrolled in retrospective cohort study. All the patients underwent enhanced full abdominal CT scan using SIMENS SOMATOM Definition Flash 64 row dual-source CT machine. CTE scans were performed from the dome of diaphragm to the symphysis pubis. The CT images in arterial and venous phase were reconstructed with 1.0 mm thin layer, and then processed in MMWP 4.0 workstation including multi-planar recombination, surface recombination and maximum density projection. The sensitivity, specificity, positive and negative predictive value, false negative rate and accuracy of preoperative CTE on obstruction, fistula and abscess were compared with intraoperative findings.

RESULTSAmong 176 patients, 122 were males and 54 were females with median age of 29 (18 to 65) years, median disease duration of 48 (1 to 240) months, median time interval from CT scan to operation of 16(1 to 30) days, and median body mass index of 17.8 (10.8 to 34.7) kg/m. Twenty-six cases (14.8%) had nutritional risk (NRS2002≥3); 23 cases (13.1%) had lesions limited to ileum; 19 cases (10.8%) had lesions limited to colon; 126 cases (71.6%) had simultaneous lesions of ileum and colon, and 8 cases (4.5%) had lesion in upper gastrointestinal tract. A total of 199 lesions of small intestine were identified by preoperative CTE, including 131 of obstruction (65.8%), 42 of fistula (21.1%), and 26 of abscess (13.1%), while 235 lesions were confirmed by operation, including 133 of obstruction (56.6%), 74 of fistula (31.5%), 28 of abscess (11.9%). The modification of planned surgical procedure due to unexpected intraoperative findings were found in 29(16.5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of preoperative CTE were 86.4%, 78.8%, 86.9% and 76.0% for obstruction; 83.8%, 79.1%, 67.5% and 90.4% for fistula; and 96.2%, 98.0%, 90.1% and 99.3 for abscess, respectively.

CONCLUSIONPreoperative CTE can effectively evaluate the lesions of intestinal obstruction, fistula and abscess in CD patients, with the highest accuracy of abscess, and has quite good consistency with intraoperative findings, which may be used as the first choice of imaging diagnosis of CD.

Abscess ; diagnostic imaging ; Adult ; Aged ; Colon ; diagnostic imaging ; surgery ; Crohn Disease ; diagnostic imaging ; surgery ; Female ; Humans ; Ileum ; diagnostic imaging ; surgery ; Intestinal Fistula ; diagnostic imaging ; Intestinal Obstruction ; diagnostic imaging ; Intestine, Small ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography, Abdominal ; methods ; statistics & numerical data ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; methods ; statistics & numerical data

Intestinal obstruction is the most common complication after gastrointestinal surgery, and will endanger the patients if not managed properly. The key to the management of intestinal obstruction includes not only the selection of treatment, but also adequate judgment of the cause, location, extent and the probability of reoperation by detailed inquiry of the history, thorough physical examination, and imaging studies, which will guide the treatment. Non-operative therapy is the mainstay of treatment for incomplete obstruction, whilebowel decompression the gut by small intestinal decompression tube, preoperative procedures including restoration of systemic homeostasis should be performed. Efforts should be made to avoid emergency laparotomy without any preparations. Procedures to avoid intestinal obstruction include all the efforts to protect the gut and the intra-abdominal viscera during laparotomy, and to clear all the foreign body and tissues by thorough lavage of the abdominal cavity with saline before closing the abdomen.
Abdomen ; surgery ; Decompression ; Decompression, Surgical ; Diagnostic Imaging ; Digestive System Surgical Procedures ; adverse effects ; Humans ; Intestinal Obstruction ; prevention & control ; therapy ; Intestine, Small ; surgery ; Laparotomy ; Postoperative Complications ; prevention & control ; Preoperative Care ; Reoperation

BACKGROUND/AIMS: The incidence of adult small bowel intussusception detected at CT has increased with advanced imaging techniques and universal utilization of CT scan. We aimed to identify factors that could predict the necessity of surgical intervention in adult patients with small bowel intussusception detected at CT during the past decade. METHODS: There were 39 cases of adult small-bowel intussusception detected at CT from January 2004 to June 2014. The data on clinical factors, radiological factors and outcomes were collected by retrospectively reviewing all available medical records. Patients were classified as surgical group and conservative group according to the outcome. Association between predictive factors and outcome was assessed by Fisher's exact test and logistic regression models. RESULTS: Among a total of 39 patients, there were 32 patients (82%) in the conservative group and 7 patients (18%) in the surgical group. Spontaneous reduction was confirmed at short-term follow-up studies (abdominal ultrasonography [n=14], single contrast small bowel series [n=14], CT [n=4]) in the conservative group. No recurrence occurred during the median follow-up period of 14.1 months (range, 0-67.5 months). Patients in the surgical group had significantly higher white blood cell (WBC) counts (OR 1.001, p=0.048), more frequent obstruction (n=4 vs. n=4, p=0.022) or leading point (n=5 vs. n=0, p<0.001) and longer intussuception length (OR 1.929, p=0.032). CONCLUSIONS: Factors associated with the necessity to resort to surgical intervention in adults with small bowel intussusceptions were higher WBC counts, presence of obstruction or leading point, and longer intussuception length. Conservative management can be considered with short-term follow-up for those without these predictive factors.
Abdomen/diagnostic imaging ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Intestine, Small/*diagnostic imaging ; Intussusception/*diagnostic imaging/surgery/therapy ; Leukocyte Count ; Male ; Middle Aged ; Odds Ratio ; Radiography, Abdominal ; Retrospective Studies ; Tomography, X-Ray Computed ; 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

OBJECTIVETo study the ultrasonographic and morphologic features of intestinal lymphoma.

METHODSThe ultrasonographic and morphologic features of 19 patients with intestinal lymphoma were retrospectively analyzed. RESULTS All the patients were confirmed as non-Hodgkin's lymphoma by endoscopy or pathology. Of these 19 cases,the involved locations included ileum(n=14),duodenum(n=3),and ileocecum(n=2). The main sonographic types included mass type(n=12),bowel wall thickening type(n=1),and nonspecific signs(n=6). The mass type was characterized by solid and cystic-solid hypoechoic(including marked hypoechoic)foci,with well-defined margin,and rich blood signals were visible in large masses. The bowel wall thickening type was characterized by the thicking of bowel walls,showing hypoechoic(including marked hypoechoic),along with posterior acoustic enhancement. The nonspecific signs included e.g. dilatation of intestine and mesenteric lymph node enlargement. Morphologically,the tumor was featured by intestinal mass in intestinal mucosa or the circumferential thickening of intestinal wall.

CONCLUSIONSmall intestinal lymphoma has typical ultrasonographic features,and ultrasonography can provide useful information in the diagnosis of small intestinal lymphoma.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intestinal Neoplasms ; diagnostic imaging ; pathology ; Intestine, Small ; diagnostic imaging ; pathology ; Lymphoma ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Ultrasonography ; Young Adult

Endoscopy ; methods ; Humans ; Intestinal Diseases ; diagnosis ; diagnostic imaging ; Intestine, Small ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; methods

INTRODUCTIONEnteric fever is a common infection in endemic areas; however, there are few reports describing the computed tomography (CT) manifestations of enteric fever. We aim to describe and illustrate CT findings in enteric fever in this study.

MATERIALS AND METHODSA retrospective search of medical records in our institute for patients with positive blood cultures for Salmonella typhi, and Salmonella paratyphi organisms yielded 39 cases. Among these patients, 12 had undergone a CT study of the abdomen. The CT images, laboratory and clinical findings of these 12 patients were reviewed.

RESULTSThe most common clinical presentation was fever (100%). Typical features of gastroenteritis were present in only over half of the patients. Liver function tests were abnormal in all patients. The most common abdominal manifestations on CT were the presence of mesenteric lymphadenopathy and splenomegaly (75%). Other features were circumferential small bowel wall thickening (58.3%) and free intraperitoneal fluid (50%). Three patients were found to have complications; one with bleeding from terminal ileal ulceration, another with an ileal perforation and the third with renal abscess formation.

CONCLUSIONCT is useful in evaluating enteric fever in patients with severe forms of presentation, a longer clinical course or less specific symptoms. Although the imaging features overlap with other abdominal infections, when combined with clinical features, travel history to endemic areas and presence of transaminitis, the diagnosis of enteric fever should be considered. CT in particular, is useful for the detection of complications such as perforation, bleeding and abscess formation.

Abscess ; diagnostic imaging ; Adolescent ; Adult ; Aged ; Ascitic Fluid ; diagnostic imaging ; Child ; Child, Preschool ; Female ; Humans ; Intestine, Small ; diagnostic imaging ; Lymphatic Diseases ; diagnostic imaging ; Male ; Middle Aged ; Paratyphoid Fever ; diagnostic imaging ; Radiography, Abdominal ; Retrospective Studies ; Salmonella paratyphi A ; Salmonella paratyphi B ; Salmonella typhi ; Splenomegaly ; diagnostic imaging ; Tomography, X-Ray Computed ; Typhoid Fever ; diagnostic imaging