Nonsurgical pneumoperitoneum detected using computed tomography: A retrospective study

Abstract Background Although several cases with pneumoperitoneum that does not require surgical intervention (nonsurgical pneumoperitoneum) have been reported, the characteristics of such cases remain unclear. The accurate diagnosis of nonsurgical pneumoperitoneum could minimize unnecessary surgery. The aim of this study was to clarify the clinical and radiological characteristics of cases with nonsurgical pneumoperitoneum detected using computed tomography. Methods This retrospective study was conducted at a single center. A total of 18513 abdominal computed tomography (CT) scans obtained between January 2010 and February 2017 were examined for pneumoperitoneum. Medical records of cases testing positive for extraluminal free air were analyzed. Results Extraluminal free air was detected in 254 examinations of 182 cases. Out of 88 examinations of 86 cases excluding iatrogenic air, colorectal perforation was the most common cause of extraluminal free air. Nonsurgical pneumoperitoneum was recognized in 25 examinations of 23 cases, and was the second most frequent. The frequency of nonsurgical pneumoperitoneum was 0.14% in all abdominal CT examinations. Most nonsurgical pneumoperitoneum cases did not exhibit severe general conditions, peritoneal signs, or leukocytosis. CT findings of bowel wall discontinuity, segmental bowel-wall thickening, perivisceral fat stranding, and abscess were not observed. Fluid collection was present in 8 of 23 cases, and the estimated volume of fluid collection was small. Pneumatosis intestinalis was simultaneously observed in 20 of 23 cases. No significant differences in the maximum diameter of intraperitoneal free air were observed between the grades of pneumatosis intestinalis (p=0.999). Follow-up CT examination, which was performed within 7 days after the detection of nonsurgical pneumoperitoneum, showed that the pneumatosis intestinalis and/or extraluminal free air often disappeared in a short time. Conclusions Nonsurgical pneumoperitoneum was common. The cause of extraluminal free air was pneumatosis intestinalis in most cases. Well-maintained general and local conditions and normal laboratory data were the clinical characteristics. The absence of CT findings indicative of peritonitis, little fluid collection, if any, and the presence of pneumatosis intestinalis were the radiological characteristics.

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Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.06.543 ◽

2018 ◽

Vol 64 (6) ◽

pp. 543-548 ◽

Cited By ~ 3

Author(s):

Sujin Ko ◽

Seong Sook Hong ◽

Jiyoung Hwang ◽

Hyun-joo Kim ◽

Yun-Woo Chang ◽

...

Keyword(s):

Bowel Wall ◽

Statistical Significance ◽

Pneumatosis Intestinalis ◽

Bowel Distension ◽

Wall Defect ◽

Ct Findings ◽

Free Air ◽

Appropriate Treatment ◽

Life Threatening ◽

Ct Features

SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word “pneumatosis” were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

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Role of Multidetector Computed Tomography in Patients of Acute Mesenteric Ischaemia and its Comparison with Clinicosurgical Outcome: A Cross-sectional Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49524.15126 ◽

2021 ◽

Author(s):

Narinder Salhotra ◽

Ritu Dhawan ◽

Anisha Galhotra ◽

Arnav Galhotra ◽

Chandan Kakkar ◽

...

Keyword(s):

Computed Tomography ◽

Bowel Wall ◽

Pneumatosis Intestinalis ◽

Wall Thickening ◽

Mesenteric Ischaemia ◽

First Line ◽

Cross Sectional ◽

Acute Mesenteric Ischaemia ◽

Bowel Wall Thickening ◽

Bowel Dilatation

Introduction: Acute mesenteric ischaemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. Early diagnosis is very important for the improved survival of the patient. Acute mesenteric ischaemia frequently presents with non specific features such as vomiting, loose stools and abdominal distension. The classical triad of fever, haematochezia and abdominal pain is seen in only 30% of the patients so, it is difficult to diagnose clinically. Multidetector Computed Tomography (MDCT) is gold standard and first line test to diagnose intestinal ischaemia. Aim: To assess the efficacy of MDCT in the diagnosis of acute mesenteric ischaemia and to compare its outcome with surgical and/or clinical findings. Materials and Methods: In this cross-sectional descriptive study conducted from 1st November 2018 to 31st May 2020, MDCT was performed on 40 patients (23 male; 17 female, age range: 28-93 years). Axial and reconstructed images of each patient were evaluated for evidence of bowel wall thickening, bowel wall attenuation, abnormal wall enhancement, bowel dilatation, mesenteric stranding, ascites, solid organ infarcts, pneumatosis intestinalis or portomesenteric gas, and mesenteric arterial or venous thrombosis. Multidetector CT findings were compared with the surgical findings and clinical outcome. Results were expressed in terms of frequency and percentages. Results: Out of 40 patients, most common cause of acute mesenteric ischaemia was arterial thrombosis, seen in 20 patients (50%) while 13 patients (32.5%) had portomesenteric venous thrombosis and 7 (17.5%) patients were diagnosed with non occlusive mesenteric ischaemia. CT finding of bowel wall thickening and bowel dilatation however non specific were seen in majority of patients (62.5% and 70%, respectively). Mesenteric fat stranding and ascites were seen in 95% and 77.5% cases respectively. Specific signs of acute mesenteric ischaemia includes hypoenhancing and non enhancing bowel walls seen in 27 patients (67.5%). Pneumatosis intestinalis and portomesenteric pneumatosis in 20% patients. A total of 27 patients underwent surgery and 13 patients were managed conservatively. On comparing the CT findings with intraoperative/ histopathological findings, accuracy of MDCT in the diagnosis of acute mesenteric ischaemia in this study was 96.39%. Conclusion: MDCT should be the first line imaging modality to diagnose acute mesenteric ischaemia and to exclude other causes of acute abdomen. It is an excellent and fast modality to diagnose bowel ischaemia, as it can visualise both the bowel and mesenteric changes as well as accurately depict the mesenteric vasculature.

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Role of MSCT in the diagnosis of perforated gall bladder (a retrospective study)

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0128-2 ◽

2020 ◽

Vol 51 (1) ◽

Cited By ~ 1

Author(s):

Mohamed M. Harraz ◽

Ahmed H. Abouissa

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Gall Bladder ◽

Acute Cholecystitis ◽

Acute Diverticulitis ◽

Wall Thickening ◽

Free Fluid ◽

Iodinated Contrast ◽

Contrast Enhanced

Abstract Background Although gall bladder perforation (GBP) is not common, it is considered a life-threating condition, and the possibility of occurrence in cases of acute cholecystitis must be considered. The aim of this study was to assess the role of multi-slice computed tomography (MSCT) in the assessment of GBP. Results It is a retrospective study including 19 patients that had GBP out of 147, there were 11 females (57.8%) and 8 males (42.1%), aged 42 to 79 year (mean age 60) presented with acute abdomen or acute cholecystitis. All patients were examined with abdominal ultrasonography and contrast-enhanced abdominal MSCT after written informed consent was obtained from the patients. This study was between January and December 2018. Patients with contraindications to contrast-enhanced computed tomography (CT) (pregnancy, acute kidney failure, or allergy to iodinated contrast agents) who underwent US only were excluded. Patients with other diagnoses, such as acute diverticulitis of the right-sided colon or acute appendicitis, were excluded. The radiological findings were evaluated such as GB distention; stones; wall thickening, enhancement, and defect; pericholecystic free fluid or collection; enhancement of liver parenchyma; and air in the wall or lumen. All CT findings are compared with the surgical results. Our results revealed that the most important and diagnostic MSCT finding in GBP is a mural defect. Nineteen patients were proved surgically to have GBP. Conclusion GBP is a rare but very serious condition and should be diagnosed and treated as soon as possible to decrease morbidity and mortality. The most accurate diagnostic tool is the CT, MSCT findings most specific and sensitive for the detection of GBP and its complications.

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Significance of Bowel Wall Thickening on Computed Tomography Scan: Higher Risk of Pathology Among African Americans Compared to Hispanics

Journal of the National Medical Association ◽

10.1016/s0027-9684(15)30882-8 ◽

2009 ◽

Vol 101 (4) ◽

pp. 345-348 ◽

Cited By ~ 2

Author(s):

Pikeshkumar Patel ◽

David Widjaja ◽

Steve Blum ◽

Mariela Glandt ◽

jagadish Akella ◽

...

Keyword(s):

Computed Tomography ◽

African Americans ◽

Bowel Wall ◽

Wall Thickening ◽

Computed Tomography Scan ◽

Bowel Wall Thickening ◽

Tomography Scan

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Computed tomography findings and in-hospital mortality in patients with rupture of type B aortic dissection

Acta Radiologica ◽

10.1177/0284185119852730 ◽

2019 ◽

Vol 61 (1) ◽

pp. 136-144

Author(s):

Tetsuhiro Otsuka ◽

Eijun Sueyoshi ◽

Yutaro Tasaki ◽

Masataka Uetani

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Hospital Mortality ◽

Female Gender ◽

Pleural Space ◽

Hazard Ratio ◽

Maximum Diameter ◽

Type B ◽

Type B Aortic Dissection ◽

Ct Findings

Background The relationships between the computed tomography (CT) findings and outcomes of patients with ruptured type B aortic dissection have not been clarified. Purpose To evaluate the initial CT findings of patients with ruptured type B aortic dissection and investigate the relationships between the initial CT findings and in-hospital mortality. Material and Methods This study was approved by the institutional review board. Thirty-three patients were diagnosed with ruptured Stanford type B aortic dissection at our hospital between 2007 and 2016 (21 men, 12 women; mean age = 76.1±10.7 years). We retrospectively evaluated the initial CT findings of ruptured type B aortic dissection and the relationships between clinical factors and in-hospital mortality using logistic regression analysis. Results Type B aortic dissections ruptured in the acute and chronic phases in 23 and 10 patients, respectively. The initial CT images showed various findings, including an open false lumen (58%), arch involvement (88%), hematomas in the pleural space (55%), hematomas in the pericardial space (18%), and the extravasation of vascular contrast material (12%). The mean maximum diameter of the affected aorta was 49.5 ± 16.1 mm. Among the 33 patients, 14 died at hospital. Female gender (hazard ratio = 10.284; 95% confidence interval [CI] = 1.61–65.54; P = 0.0136) and the presence of a hematoma in the pleural space (hazard ratio = 6.803; 95% CI = 1.07–43.24; P = 0.0421) were found to be predictors of in-hospital mortality. Conclusion Female gender and the presence of a hematoma in the pleural space are significant predictors of in-hospital mortality in patients with ruptured type B aortic dissection.

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Chronic Active Epstein-Barr Virus-Associated Enteritis: CT Findings and Clinical Manifestation

BioMed Research International ◽

10.1155/2020/2978410 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Bo Zhang ◽

Xia Wang ◽

Xiaoyan Tian ◽

Yongping Cai ◽

Xingwang Wu

Keyword(s):

Epstein Barr Virus ◽

Bowel Wall ◽

Clinical Symptoms ◽

Wall Thickening ◽

Barr Virus ◽

Ct Findings ◽

Pathologic Findings ◽

Bowel Wall Thickening ◽

Epstein Barr ◽

Fat Stranding

Aim. To improve the identification and computed tomography (CT) diagnostic accuracy of chronic active Epstein-Barr virus (EBV)-associated enteritis (CAEAE) by evaluating its CT findings and clinical manifestation. Methods. The data of three patients with pathologically and clinically confirmed CAEAE who underwent CT enterography (CTE) were retrospectively reviewed from January 2018 to October 2019. The following data were evaluated: imaging characteristics (length of involvement, pattern of mural thickening, pattern of attenuation, perienteric abnormalities), clinical symptoms, endoscopic records, laboratory examinations, and pathologic findings. Results. Based on CT findings, two patients demonstrated segmental bowel wall thickening (involvement length >6 cm), asymmetric thickening, layered attenuation, fat stranding, and adenopathy, whereas the remaining one had no positive finding. The endoscopic results of all patients showed numerous irregular ulcers in the colon, and one patient had a focal esophageal ulcer. The major clinical symptoms were abdominal pain (n=3), retrosternal pain (n=1), fever (n=3), diarrhea (n=2), hematochezia (n=1), and adenopathy (n=3). The main laboratory examination indicators were increased serum EBV DNA load (n=1) and increased inflammatory markers (n=3). With regard to the main pathologic findings, all patients showed positive EBV-encoded RNA (EBER) situ hybridization in the colonic biopsy specimen, with one patient being positive in the esophagus. Conclusion. CAEAE is rare and is usually misdiagnosed as inflammatory bowel disease (IBD). The imaging features of CAEAE overlap with those of Crohn’s disease and ulcerative colitis. The presence of segmental and asymmetric bowel wall thickening, layered attenuation, and fat stranding in the CTE image may be helpful in differentiating CAEAE from IBD.

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S1549: Association Between Serum Albumin Levels and Computed Tomography (CT) Findings of Colon Wall Thickening (CWT)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2010.03.324 ◽

2010 ◽

Vol 71 (5) ◽

pp. AB191-AB192

Author(s):

Hiral Shah ◽

Bikram S. Bal ◽

Raman Battish ◽

Michael D. Crowell ◽

Rohini R. Vanga ◽

...

Keyword(s):

Computed Tomography ◽

Serum Albumin ◽

Wall Thickening ◽

Colon Wall ◽

Ct Findings

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A scoring system based on computed tomography for the correct diagnosis of xanthogranulomatous cholecystitis

Acta Radiologica Open ◽

10.1177/2058460120918237 ◽

2020 ◽

Vol 9 (4) ◽

pp. 205846012091823 ◽

Cited By ~ 1

Author(s):

Ryota Ito ◽

Takashi Kobayashi ◽

Gou Ogasawara ◽

Yoshiharu Kono ◽

Kazuhiko Mori ◽

...

Keyword(s):

Computed Tomography ◽

Confidence Interval ◽

Gallbladder Cancer ◽

Scoring System ◽

Correct Diagnosis ◽

Chronic Cholecystitis ◽

Wall Thickening ◽

Xanthogranulomatous Cholecystitis ◽

Ct Findings ◽

Pericholecystic Abscess

Background Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis. The differential diagnoses of XGC include gallbladder cancer (GBC), adenomyomatosis, and actinomycosis of the gallbladder. Purpose To assess the usefulness of computed tomography (CT) findings in the diagnosis of XGC and differentiation from GBC. Material and Methods We retrospectively assessed the pathological and radiological records of 13 patients with pathologically proven XGC and 33 patients with GBC. Results Significant differences were observed for the following five CT findings: diffuse wall thickening (XGC = 85%, GBC = 15%, P < 0.01); absence of polypoid lesions (XGC = 100%, GBC = 48%, P < 0.01); intramural nodules or bands (XGC = 54%, GBC = 9%, P < 0.01); pericholecystic infiltration (XGC = 69%, GBC = 9%, P < 0.01); and pericholecystic abscess (XGC = 23%, GBC = 0%, P = 0.018). We defined the scoring system based on how many of the five CT findings were observed. Our scoring system, which included these findings, revealed that patients with three or more findings had sensitivity of 77% (95% confidence interval [CI] = 57–87) and specificity of 94% (95% CI = 86–98). Conclusion Our scoring system can assist in the differentiation of XGC from GBC.

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Impact of Initial Computed Tomography Findings on Management of Atypical Urinary Cytology of the Upper Urinary Tract

Urologia Internationalis ◽

10.1159/000512978 ◽

2021 ◽

pp. 1-5

Author(s):

Kotaro Takemura ◽

Taketo Kawai ◽

Yusuke Sato ◽

Jimpei Miyakawa ◽

Satoru Taguchi ◽

...

Keyword(s):

Computed Tomography ◽

Urinary Tract ◽

Upper Urinary Tract ◽

Wall Thickening ◽

Urinary Cytology ◽

Class Iii ◽

Ct Findings ◽

Retrograde Ureteropyelography ◽

Tumor Like Lesions

Introduction: Management of patients with atypical urinary cytology (class III) of the upper urinary tract is often complicated because some patients develop upper urinary tract urothelial carcinoma (UTUC). Here, we aimed to help define the optimal management of these patients. Methods: We investigated 31 patients who underwent retrograde ureteropyelography (RP) and were diagnosed with atypical findings of upper urinary tract cytology. Results: UTUC was revealed in 17 of 31 patients during the follow-up period of 1 year or longer. Tumor-like lesions and wall thickening in the upper urinary tract on initial computed tomography (CT) were significant predictors of UTUC (p = 0.0002 and p = 0.012, respectively). All 11 patients with tumor-like lesions and 3 of 8 patients with wall thickening on initial CT underwent nephroureterectomy, and UTUC was confirmed histologically. Moreover, 3 of 12 patients with hydronephrosis only or with normal findings later went on to develop UTUC. Repeated RP performed within 6 months from the initial RP was able to distinguish patients with UTUC from those without, even in individuals with normal CT findings. Discussion/Conclusion: Repeated RP based on initial CT findings is recommended in patients with atypical urinary cytology of the upper urinary tract. Nephroureterectomy without repeated RP may be warranted in patients with tumor-like lesions on initial CT findings.

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