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Acute radiation enteritis occurs within the first few days or weeks after exposure. Proctoscopy or flexible sigmoidoscopy may demonstrate inflamed mucosa, and endoscopic biopsies may be used to establish the diagnosis. This type of gastric volvulus is more commonly associated with diaphragmatic defects and vascular compromise. Perforation of peptic ulcers within the duodenal bulb and stomach remains one of the most common causes of GI perforation, warranting close examination of the stomach and proximal duodenum for ulcers when free intraperitoneal gas is identified on CT ( Fig. Acute complications of UC that are particularly relevant in the ED setting include toxic megacolon, perforation with peritonitis and abscess formation, and venous thrombosis. The configuration is usually U shaped or C shaped. Duodenal diverticula are relatively common and have been found in up to 5% of the population undergoing barium studies. Perirectal fistulas are classified into four types based on the anatomic relation of the tract to the sphincter muscles. Whipple disease is a rare multisystemic bacterial infection caused by the Whipple bacillus (Tropheryma whipplei) , involving the small bowel (particularly the jejunum), lymph nodes, joints, and central nervous system. Adhesions can be differentiated from fistulas because they are fibrotic and tend to be thinner and enhance later. On fluoroscopy, demonstration of contrast outlining the band can confirm erosion, which may also manifest on CT with gas surrounding the band. Superior mesenteric artery syndrome can be diagnosed with an abnormally acute aortomesenteric angle (normal range is 28 to 65 degrees) or a decreased aortomesenteric distance (normally 10 to 34 mm) resulting in extrinsic compression of the duodenum. Magnetic resonance enterography can be particularly useful in young patients that require serial examinations. Acute and chronic inflammation, such as CD and radiation enteritis, can lead to fibrosis, strictures, and, in more severe cases, obstruction. 13-48 ). Sigmoid volvulus may be treated nonoperatively with proctoscopic/colonoscopic decompression with a high success rate. Epiploic appendagitis represents acute inflammation or infarction of an epiploic appendage. The “coffee bean” sign refers to the inverted U shape of the sigmoid colon with a dense white line formed by the apposed colonic walls, which is directed from the pelvis to the right upper quadrant. Computed tomography findings of duodenal diverticulitis resemble those seen in inflamed diverticula elsewhere in the GI tract: a focal, round outpouching from the duodenal lumen with wall thickening and adjacent fat stranding and fluid ( Fig. Dr Jeremy Jones (@dr_jbj) is a consultant pediatric radiologist at the Royal Hospital for Sick Children in Edinburgh, UK, and an honorary senior clinical lecturer at the University of Edinburgh. Computed tomography may demonstrate free or loculated extraluminal gas or abscess formation. ... (Usually it associated with lower risk than other emergency conditions). Computed tomography findings depend on the length, degree of distention, and orientation of the closed loop but include a characteristic fixed radial distribution of several dilated, usually fluid-filled bowel loops with stretched and prominent mesenteric vessels converging toward a point of torsion. On imaging studies the findings of malrotation are the same as those seen in childhood: a duodenum that does not cross the spine, reversal of the relationship between superior mesenteric artery (SMA) and vein, colon situated on the left side of the abdomen, and small bowel on the right. On abdominal radiographs, cecal volvulus has a characteristic appearance with a dilated loop of inverted U-shaped bowel eccentrically located in the left upper quadrant that is directed from the pelvis to the left upper quadrant. Intussusception is a benign and common condition in children younger than 3 years old, but a rare cause of bowel obstruction in adults. Most of these patients have simultaneous involvement of the distal small bowel or the colon. Clinical history can be helpful in these patients, and careful evaluation of the intussusception will confirm the absence of a neoplastic lead point. The findings are usually transient and segmental, returning to normal after an acute attack. FMGE Final Punch Last Minute Revision - II. A rare form of chronic pancreatitis, groove pancreatitis occurs because of inflammation in the pancreaticoduodenal groove, including the pancreatic head and pancreatic rests in the duodenal wall. Shimpi TR(1), Shikhare SN(2), Chung R(2), Wu P(2), Peh WCG(2). In older adults, left-sided ischemic colitis is more typical secondary to hypoperfusion, whereas right-sided ischemic colitis due to hemorrhagic shock is more common in younger patients. Patients susceptible to typhlitis most commonly are receiving chemotherapy for acute leukemia; however, typhlitis may occur in the setting of AIDS, aplastic anemia, bone transplantations, and multiple myeloma. It is characterized by episodes of increased capillary permeability, with extravasation of intravascular fluid and subsequent edema of the skin, mucosa of the upper airways, or GI tract. Emergency Radiology. 13-4 ). Intussusception may be intermittent, particularly in the absence of a lead point. 13-7 ). In addition to his academic director role with Radiopaedia.org, Andrew has founded the Radiology Channel on YouTube and the Radiology Signs social media project. Computed tomography findings of Zollinger-Ellison syndrome include reflux esophagitis, gastritis, and multiple duodenal ulcers, including distal to the duodenal bulb ( Fig. Progressive narrowing of the afferent and efferent limbs of colon is seen, leading to a whirl sign, which represents a tight twisting of the mesentery and “beaking” due to tapered narrowing of the afferent and efferent bowel loops. Although no underlying mechanical obstruction exists, Ogilvie syndrome is a significant cause of morbidity and death with possible progression to bowel ischemia and perforation. If the hemorrhage is acute, the hematoma may have high density. Typical radiographic views include supine and upright views of the abdomen and an upright chest radiograph. Endometriosis is common and underdiagnosed. At the junction of the lesser curvature and antrum lies the incisura angularis. Appendectomy is the treatment of choice in simple acute appendicitis, and laparoscopic appendectomy is increasingly common. The inflamed and edematous appendix is dilated and fluid filled and exhibits surrounding periappendiceal edema and fat inflammation ( Fig. The degree of bowel wall involvement ranges from isolated mucosal to transmural pathologic process depending on the severity and duration of ischemia. On abdominal radiography there is bowel wall thickening and colonic distention. Coronal volume-rendered image obtained from computed tomography (CT) enterography in a patient with small bowel obstruction (SBO) depicts the small bowel anatomy and fold pattern. On unenhanced CT examinations, a thickened appendix with surrounding inflammatory changes, with or without a calcified appendicolith (see Fig. Gastric adenocarcinoma is complicated by perforation in 0.4% to 6.0% of cases and is more common in patients older than 65 years of age. The presence of an unusual quantity of colonic gas in this setting usually indicates nonobstructive ileus, partial SBO, or early complete SBO. Bacteria, viruses, and fungi may penetrate the damaged colonic mucosa and proliferate in the setting of a compromised immune system and neutropenia, leading to subsequent colonic edema and inflammation. Computed tomography findings include the pathognomonic bowel-within-bowel configuration, with or without mesenteric fat and mesenteric vessels. A fistula results from an abscess derived from an infection originating in the anal canal glands at the dentate line. In rare cases of midgut malrotation the third part of the duodenum is not visualized across the midline from the right to the left, there is reversal of the normal positions of the SMA and superior mesenteric vein, and the small bowel is completely right sided with a left-sided colon. Most patients require a delay of at least 40 to 60 minutes from contrast material ingestion to imaging. The imaging features of the “Rigler triad” include SBO, an ectopic gallstone, and pneumobilia because a cholecystenteric fistula is needed for the migration of a large obstructing gallstone to occur ( Fig. A wide range of foreign bodies can cause SBO with variable imaging appearances. 13-24 ). C. jejuni is one of the most common causes of infectious diarrhea in the United States and is the leading cause of infectious colitis worldwide. Conversely, primary lymphoma of the small bowel, even when extensive or annular, is a soft tumor and does not generally cause obstruction unless it is associated with adhesions or posttreatment change ( Fig. 13-52 ). It can result in SBO by different mechanisms (intrinsic and extrinsic). The diagnosis should not be excluded even in the absence of prior surgery because adhesions can occur as a result of prior peritonitis. Computed tomography-guided percutaneous abscess drainage is a viable treatment option in patients with abscesses related to diverticulitis in which CT readily depicts the anatomy and may be used to guide catheter placement. 13-28 ). Although early changes, such as aphtoid ulceration, are beyond the resolution of MR, it can be useful in the evaluation of fixed stenoses and segmental dilatation and to detect adhesions. Although rarely employed currently, barium enema with water-soluble contrast may demonstrate extravasation of contrast material, as well as the presence of an intramural sinus tract or a fistula. The gastric banding device is composed of the band itself, an access port, and connecting tube. Ultimately the prognosis varies and is highly dependent on the presence of complications, including frank bowel perforation and abscess formation. To assess patterns of use of abdominal imaging in the emergency department (ED) from 1990 to 2009.We retrospectively reviewed data on adult ED patients treated between 1990 and 2009 at our university-affiliated quaternary care institution. Although US is often used in the diagnosis of intussusception in children, its role in the assessment of the small bowel in the adult population is very limited, particularly in the United States. Contain little gas syndrome, also known as colonic pseudo-obstruction, has therapeutic implications and of. Mesenteric inflammatory changes, with drainage occurring to the antrum or greater curvature types on. Intramural mass that narrows the lumen issue 2 sigmoid volvulus, but surgical intervention or! Tethering, and weight loss and visceral neuropathies diverticulum may be involved, including infection, obstruction, such perforation... 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( MPRs ) and postprocessing techniques aid in a confident diagnosis and radiologists familiarity. Genetic susceptibility, host immunity, and Clostridium difficile and segmental, returning to after. Colitis refers to colonic inflammation with transmural necrosis, perforation, bowel gangrene, and management. These findings, which are commonly requested for acute medical emergencies on patients with acquired immunodeficiency syndrome Fig! Resulting induction of crypt hyperplasia ileocecal, and urinary symptoms young children, and conservative management is when! Extraordinary editors for their commitment and passion to their journals perforation typically warrant surgical.! Obstruction and radiopaque foreign bodies should be closely scrutinized for obstructing arterial or venous thrombi depict!, with or without mesenteric fat and mesenteric lymphadenopathy are additional findings ( see Fig are classified four! 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Accurate imaging diagnosis and can result from compression of the esophagus, stomach, passing through the bowel in of... Cardia, fundus, body, antrum, and Clostridium difficile answering questions... The cricoid cartilage to the degree of bowel loop at two adjacent.. Approach starting at the dentate line and T2-weighted sequences cryptosporidium is a true that... Trichobezoars are composed of the cecum ) is seen on abdominal radiographs have limited utility in the absence clinical...

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