Segmental dilatation of the small bowel: report of three cases and literature review

Article Abstract:

Dilatation (expansion) of parts of the small bowel (segmental dilatation) is a rare congenital condition that occurs without thickening of the muscles that surround the bowel. The condition occurs mainly in children and, although it is not associated with a specific set of symptoms, segmental dilatation may coexist with other serious abdominal disorders in the neonatal period (first six weeks after birth). Radiological examination, using barium as a radioactive contrast agent, demonstrated morbid (diseased) anatomy. Three cases of small bowel segmental dilation were studied: an infant girl who vomited after feedings and displayed an enlarged abdomen; a five-year-old boy with a history of recurrent mild abdominal pain; and a six year-old-boy who had severe recurrent abdominal pain with vomiting of bile. All of the patients underwent a laparotomy (surgical opening of the abdomen). Researchers noted three main categories of symptoms: (a) signs of bowel obstruction in the neonatal period (vomiting and absence of a bowel movement); (b) anemia (low red blood cell count), which can be severe and is usually caused by blood loss; (c) signs and symptoms of bowel obstruction in older infants, children, and adults. After reviewing 33 additional cases of small bowel segmental dilation, researchers conclude that failure to demonstrate a bowel lesion in older children with blood loss prolonged the period of illness symptoms and seriously increased the likelihood that invasive examinations would be performed. The report advocates an x-ray barium study of the small bowel in cases where endoscopy (a visual examination of the stomach and small intestine) can not find a cause for blood loss. However, it is not suggested that barium studies of the small bowel be performed in all children with intermittent abdominal pain. For most children with these symptoms, a standard x-ray image of the small bowel is sufficient.

Case studies, Physiological aspects, Intestines, Gastrointestinal system, Contrast media, Contrast media (Chemicals), Abdomen, Diagnosis, Radioscopic, Radioscopic diagnosis, Intestine, Small, Small intestine, Intestinal obstruction, Diagnosis, Surgical, Surgical diagnosis

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Hemoptysis: CT-bronchoscopic correlations in 58 cases

Article Abstract:

Hemoptysis is the spitting of blood from the lungs, and is indicative of lung disease. A patient with this symptom will usually be examined using fiberoptic bronchoscopy (FOB), which involves inserting an instrument into the airways to examine them and the lungs. Computed tomography (CT) has been reported to be an effective diagnostic tool for detecting tumors within the lungs; CT also has the advantage of being noninvasive (FOB is invasive because it involves entering a body cavity). This study examined the use of CT as a diagnostic tool for patients with hemoptysis. Results from CT were compared with those of the conventional diagnostic tool, FOB. Fifty-eight patients with hemoptysis were first examined by X-ray and then using CT, followed by FOB as well as other diagnostic methods. The X-rays of 23 patients showed normal results. CT results proved positive (meaning disease was found) in 16 of these patients, with a variety of findings. Five of these were non-specific results that were missed by FOB. In the 35 patients who had positive X-rays, CT findings were positive in all 35 cases with seven of these results being non-specific. FOB was nondiagnostic in 14 of these cases. When compared with basic X-rays, CT helped to specifically diagnose the disorder in 9 of 23 cases in which X-rays were normal, 6 of 15 cases in which X-rays showed focal infiltrates or cavities, and 14 of 15 cases in which X-rays showed masses or atelectasis (collapsed parts of the lungs). FOB was mainly of additional value in specific diagnosis when X-rays showed masses or atelectasis; it was less effective when X-rays were normal. Other studies have shown that CT detected a very high percentage of lesions that are found using FOB. These results indicate that CT can be useful in the diagnosis of disorders related to the clinical symptom of hemoptysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

CT imaging, CAT scans, Lung diseases, Bronchoscopy

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Fatal carcinoid crisis after percutaneous fine-needle biopsy of hepatic metastasis: case report and literature review

Article Abstract:

Fine-needle aspiration biopsy (FNAB) is a technique involving insertion of a needle into tissues or organs to obtain samples for laboratory analysis. FNAB is often used to obtain samples from suspected cancerous tumors. Although the procedure is generally safe, it can pose a risk of serious side effects. Tumor disruption by the needle can lead to a release of hormones or other substances. Depending on the type and amount released, serious problems can occur. The case is reported of a 45-year-old man who underwent FNAB to obtain samples from tumors on his liver. The patient had undergone sonographic evaluation, diagnostic imaging utilizing high-frequency sound waves. Results showed a number of nodules on his liver. FNAB was performed on one of the lesions. Almost immediately after the biopsy was performed, the patient experienced nausea and faintness. Within five minutes, the symptoms worsened and the patient's heart stopped. He did not respond to resuscitation efforts. An autopsy showed the tumor was a carcinoid tumor. This type of tumor secretes hormones and other substances that are vasoactive, i.e. that affect blood vessels. It appeared that FNAB had caused a release of serotonin from the tumor. This substance causes constriction or narrowing of blood vessels. Although this type of reaction to FNAB is rarely reported, patients with indications of carcinoid syndrome should not undergo the procedure unless absolutely necessary. For those that do undergo the procedure, precautions such as medication with somatostatin should be taken prior to biopsy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Liver, Liver cancer, Liver biopsy, Carcinoid, Carcinoid tumor, Biopsy, Needle, Needle biopsy

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