CT ENTEROCLYSIS VERSUS CT ENTEROGRAPHY IN THE EVALUATION OF SUSPECTED SMALL BOWEL PATHOLOGIES - A CASE SERIES

Caecal volvulus is an infrequent cause of acute surgical abdomen, where an abnormally mobile cecum twists on its own axis. It can lead to the development of closed-loop obstruction, small bowel ischaemia and perforation. Early recognition and prompt treatment is key; however, due to the rarity of this pathology, it is seldom listed as a differential diagnosis. Here, we present a single-centre case series of two patients presenting with caecal volvulus to an Emergency Surgery Unit at a University Hospital.

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Computer-Aided Detection of Small Bowel Strictures for Emergency Radiology in CT Enterography

Virtual Colonoscopy and Abdominal Imaging. Computational Challenges and Clinical Opportunities - Lecture Notes in Computer Science ◽

10.1007/978-3-642-25719-3_13 ◽

2011 ◽

pp. 91-97

Author(s):

Nisha I. Sainani ◽

Janne Näppi ◽

Dushyant V. Sahani ◽

Hiroyuki Yoshida

Keyword(s):

Small Bowel ◽

Emergency Radiology ◽

Computer Aided Detection ◽

Ct Enterography ◽

Computer Aided

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373. Immune Reconstitution Inflammatory Syndrome in Patients with HIV/AIDS and Histoplasmosis: A Case Series

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.446 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S195-S195 ◽

Cited By ~ 1

Author(s):

Afroditi Boulougoura ◽

Elizabeth Laidlaw ◽

Gregg Roby ◽

Yolanda Mejia ◽

Alice Pau ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Histoplasma Capsulatum ◽

Case Reports ◽

Case Series ◽

The United States ◽

Inflammatory Syndrome

Abstract Background Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV infection is the unexpected clinical deterioration due to worsening (paradoxical) or uncovering (unmasking) of an infection or malignancy upon initiation of antiretroviral therapy (ART). Histoplasma capsulatum (H. capsulatum) is the most common endemic mycosis in patients with AIDS, usually manifesting as disseminated disease at CD4 counts < 150 cells/μl. In the ART era, histoplasmosis IRIS has been described in case reports, but there has been a limited description regarding clinical presentations and pathogenesis in the United States. Methods ART-naive HIV+ patients with a CD4+ T-cell count < 100 cells/µL enrolled in prospective studies at the National Institutes of Health (NIH) (NCT00286767, NCT02147405) were evaluated to identify those with histoplasmosis and followed after ART initiation to identify those who would eventually develop IRIS. Results From a total of 271 patients, we identified 9 patients with histoplasmosis. The median age, CD4+ count and HIV VL of these 9 patients was 36 years, 40 cells/mm3 and 193,184 copies/mL, respectively. Two patients developed IRIS only to histoplasmosis (1 unmasking and 1 paradoxical), 2 patients developed IRIS to both histoplasmosis and nontuberculous mycobacteria (NTM) and 3 patients developed IRIS to other infections (1 VZV, and 2 NTM). The manifestations of histoplasmosis IRIS in our cohort ranged from worsening lymphadenopathy to small bowel obstruction and worsening pulmonary symptoms. Conclusion Histoplasma-related IRIS can present with worsening lymphadenopathy, small bowel obstruction, and worsening pulmonary symptoms. The emergence of IRIS appears to be very common in people with HIV and disseminated histoplasmosis but the underlying trigger may be histoplasma, other co-infections or both. Disclosures All authors: No reported disclosures.

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P108 TEDUGLUTIDE USE IN CROHN’S DISEASE: A CASE SERIES

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.053 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S23-S23

Author(s):

Adeeti Chiplunker ◽

Christina Ha ◽

Shirley Paski

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Median Duration ◽

Dose Adjustment ◽

Medical Center ◽

Case Series ◽

Dose Interval ◽

Retrospective Case ◽

Inflammatory Bowel

Abstract Background Teduglutide is a glucagon-like peptide-2 (GLP-2) analogue with trophic effects on the intestinal mucosa to increase the absorptive surface area and enhance nutrient and fluid absorption of the small bowel (SB).1 It has been shown to reduce parenteral nutrition (PN) and intravenous fluid (IVF) requirements and is an important adjunct in the medical management of short bowel syndrome (SBS).1–2 Crohn’s disease (CD) is an important etiology of SBS but use of teduglutide in this population can be challenging. Aim The aim of this case series was to describe the use of teduglutide in CD patients. Methods A retrospective case series of all CD patients with SBS who used teduglutide at the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center. Age, duration of SBS, length of remaining SB and colonic continuity status were recorded. BMI, average daily PN kilocalories (kcal), and IVF requirements were recorded at the time of teduglutide initiation. The duration of teduglutide use was calculated. Teduglutide dose, dose adjustment history, reason for dose adjustment, and therapy complications were noted. Results 9 patients were included (5 male/4 female). Median age was 57 years (IQR 32). Median length of remaining small bowel was 60cm (IQR 27.5) and median duration of SBS was 8 years (IQR 9.83). Median BMI at teduglutide initiation was 18.66 (IQR 4.29) with a median duration of PN of 4.5 years (IQR 9.42) and median PN kcal/day of 971.43 (IQR 518). The median duration of teduglutide was 1.1 years (IQR 3.4). 4 patients (44%) had a teduglutide dose change. 2 patients had dose interval extended from daily to every other day to reduce injection burden. 1 patient developed obstructive symptoms on daily dosing, which resolved when the dose interval was extended to every other day. 1 patient had to stop therapy due to a small bowel obstruction requiring hospitalization. 8 patients (88%) were able to wean or stop PN/IVF with addition of teduglutide. 1 patient had to restart PN despite teduglutide therapy. Table 1. Discussion Teduglutide is effective in Crohn’s disease patients and facilitates weaning of PN and IVF requirements. Most patients tolerate the recommended dose with daily injections, but the dose interval can be extended to every other day to reduce obstructive symptoms or reduce the injection burden without affecting ability to wean PN/IVF. References

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Assessing Small Bowel Stricturing and Morphology in Crohn’s Disease Using Semi-automated Image Analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz196 ◽

2019 ◽

Vol 26 (5) ◽

pp. 734-742 ◽

Cited By ~ 3

Author(s):

Ryan W Stidham ◽

Binu Enchakalody ◽

Akbar K Waljee ◽

Peter D R Higgins ◽

Stewart C Wang ◽

...

Keyword(s):

Image Analysis ◽

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Structural Damage ◽

Clinical Decision Making ◽

Tertiary Care ◽

Automated Image Analysis ◽

Image Analysis System ◽

Ct Enterography

Abstract Background Evaluating structural damage using imaging is essential for the evaluation of small intestinal Crohn’s disease (CD), but it is limited by potential interobserver variation. We compared the agreement of enterography-based bowel damage measurements collected by experienced radiologists and a semi-automated image analysis system. Methods Patients with small bowel CD undergoing a CT-enterography (CTE) between 2011 and 2017 in a tertiary care setting were retrospectively reviewed. CT-enterography studies were reviewed by 2 experienced radiologists and separately underwent automated computer image analysis using bowel measurement software. Measurements included maximum bowel wall thickness (BWT-max), maximum bowel dilation (DIL-max), minimum lumen diameter (LUM-min), and the presence of a stricture. Measurement correlation coefficients and paired t tests were used to compare individual operator measurements. Multivariate regression was used to model identification of strictures using semi-automated measures. Results In 138 studies, the correlation between radiologists and semi-automated measures were similar for BWT-max (r = 0.724, 0.702), DIL-max (r = 0.812, 0.748), and LUM-min (r = 0.428, 0.381), respectively. Mean absolute measurement difference between semi-automated and radiologist measures were no different from the mean difference between paired radiologists for BWT-max (1.26 mm vs 1.12 mm, P = 0.857), DIL-max (2.78 mm vs 2.67 mm, P = 0.557), and LUM-min (0.54 mm vs 0.41 mm, P = 0.596). Finally, models of radiologist-defined intestinal strictures using automatically acquired measurements had an accuracy of 87.6%. Conclusion Structural bowel damage measurements collected by semi-automated approaches are comparable to those of experienced radiologists. Radiomic measures of CD will become an important new data source powering clinical decision-making, patient-phenotyping, and assisting radiologists in reporting objective measures of disease status.

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