European journal of radiology
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Acute bowel ischemia represents one of the most dramatic abdominal emergencies and, despite the fact it is more and more frequently observed in clinical practice, its mortality rate remains very high. In recent years Computed Tomography (CT) has proved to be a valid diagnostic tool in the evaluation of patients with acute abdominal syndrome and in the visualization of early signs of bowel ischemia. This paper reviews the aetiological and pathophysiological aspects as well as a broad spectrum of CT findings of this clinical condition.
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Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. ⋯ The use of intravenous (i.v.) contrast material allows simultaneous evaluation of osseous and vascular structures within the affected area. Postoperative studies in patients with orthopaedic hardware also benefit from volume-rendered imaging. Volume rendering eliminates most streak artifact and produces high-quality images on which the relationships among hardware, bones, and bone fragments are well demonstrated.
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The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation of the intestinal loops, however recently some Authors attested the increasing important role of sonography in the acute abdominal disease. Aim of our report is to demonstrate the value of free fluid detected by US in differentiating between low and high-grade small bowel obstruction. ⋯ Our experience using sonography in suspicion of SBO (small bowel obstruction) suggests the usefulness of this imaging modality to differentiate a functional or obstructive ileus, demonstrating the evidence of intestinal peristalsis. Furthermore, the presence of a large amount of fluid between dilated small bowel loops suggests worsening mechanical small bowel obstruction, that requires not a medical therapy but immediate surgery.
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The CT diagnosis of bowel and mesenteric injuries is difficult and warrants optimal technique and skilled interpretation. We retrospectively reviewed 36 consecutive patients with blunt traumatic injuries to the bowel and mesentery at our regional level I trauma center during the past 3 years. Physical examination, laboratory, Computed tomographic (CT), and intraoperative findings were compared. ⋯ However, CT cannot be used as the sole indicator in cases with isolated thichened bowel wall, mesenteric hematoma, bowel hematoma, pneumoperitoneum or gas bubbles. Persistent, active extravasation of intravenous constrast medium from the mesenteric vessels, in isolation or associated with further injuries, requires immediate exploration and repair; disruption of bowel wall and extravasation of oral contrast are definite signs of bowel rupture. Close clinical observation, monitoring, and surgical expertise are mandatory for appropriate management.
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Editorial Historical Article
Emergency radiology as a sub-speciality has come of age.