Documenti di Didattica
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Case 1
A 58-year-old man presented with abdominal pain, nausea, vomiting.
Case 1
Rigler Triad
Partial small bowel obstruction Gas in biliary tree Ectopic calcified gallstone
Case 2
A 63-year-old man presented with abdominal pain, nausea, vomiting.
Case 2
Stepladder pattern Multiple air-fluid levels (> 3 ), different height in the same loops Dilated small bowel lumen (> 3cm) with no air in the colon Diagnosis: Small bowel obstruction (CA cecum)
SBO Etiologies
Adhesion/Fibrosis Internal hernia Volvulus Intussusception GS ileus Abscess Neoplasm
Case 3
A 45-year-old man presented with abdominal pain and fever.
Case 3
Abscess at the RLQ causing partial SBO Possible etiologies
Ruptured appendicitis Ruptured diverticulitis SB infarction with perforation CA colon with perforation
Case 4
A 26-year-old female presented with recurrent abdominal pain.
Case 4
Cluster of small bowel loops at the leftside abdomen with marked dilatation of the duodenum suggestive of left paraduodenal hernia (through fossa of Landzert)
Case 5
A 58-year-old female presented with abdominal pain.
Case 5
Relatively thickened, regular folds with minimal nodularity This pattern implies relatively even distribution of submucosal deposition. It is usually caused by edema or hemorrhage.
Hemorrhage (Focal)
Anticoagulant therapy/coagulopathies Ischemia (SMA, SMV thrombosis; hypoperfusion) Vasculitis
Case 5
Thrombus within the SMV Diffusely thickened small bowel wall Dx: Ischemic bowel, SMV thrombosis
Case 6
A 58-year-old man presented with abdominal distension and pain.
Case 6
String of pearls appearance with relatively absence of air in colon, indicative of small bowel obstruction Site of obstruction is possibly proximal.
SBO Etiologies
Adhesion/Fibrosis Internal hernia Volvulus Intussusception GS ileus Abscess Neoplasm
Case 6
Coil-spring appearance, indicative of intussusception Dx: Lymphoma
Case 7
A 74 year-old man presented with abdominal pain and fever.
Case 7
Jejunal diverticula with inflammatory mass encasing the small bowel loops and extraluminal air bubbles Dx: Rupture jejunal diverticulitis
Case 8
A 59-year-old man, check up.
Case 8
A pedunculated polyp with lobulated contour at the descending colon Diagnosis: Tubulovillous adenoma
Colonic Polyp
Hyperplastic polyp
Sessile polyp < 5 mm
Adenomatous polyp
Tubular adenoma Tubulovillous adenoma Villous adenoma
Case 9
A 56-year-old man presented with constipation.
Case 8
Circumferential mass at rectum with a small processional node Dx: CA rectum, Modified Dukes C
T3 (servos) N1 (1-3 regional l.n.) M0 (No distant met)
Case 10
A 60-year-old man presented with melon.
CT Coronagraph
Case 10
Intriguingly lobulated mass with relatively thin wall Dx: CA rectum, Modified Dukes A
T2 (muscular propia) N0 M0
2 cm polyp
Case 11
A 46-year-old man presented with abdominal pain and distension.
Case 11
Distended cecum rotates into the LUQ Dx: Cecal volvulus
Case 12
A 55-year-old man presented with fever and abdominal pain.
Case 12
Extraluminal air bubbles at LLQ with evidence of sigmoid diverticulosis Dx: Ruptured sigmoid diverticulitis
Case 13
A 45-year-old man presented with fever and abdominal pain.
Case 13
Dilated appendix with air bubbles dissecting in its wall and rupture into the peritoneal cavity Dx: Rupture acute appendicitis
Case 14
A 45-year-old man presented with abdominal distension.
Case 14
Omental cake Implantation with mass effect over the liver and splenic surfaces (scalloping sign) Ascites Rim calcified cyst at the RLQ Dx: Pseudomyxoma peritonei, from ruptured mucocele
Case 15
A 57-year-old presented with acute abdominal pain and diarrhea.
Case 15
Diffuse thickening of sigmoid colon D/Dx:
Infectious colitis Ischemic colitis Pseudomembranous colitis Inflammatory bowel (UC, Crohns)
Case 15
Dx: Ischemic colitis
Conclusion
Normal anatomy SBO
Gallstone ileus CA cecum Abscess (SB infarction with perforation) Intusussception (lymphoma)
Internal hernia
Left paraduodenal hernia
Conclusion
Colonic polyp Carcinoma (T3N1, T2N0) Cecal volvulus Ruptured diverticulitis Ruptured appendicitis Pseudomyxoma peritonei (ruptured mucocele) Ischemic colitis