The term Ogilvie syndrome has been applied to both the acute and chronic forms of colonic pseudo-obstruction, though some authors believe this term applies to the acute form, which represents a reversible condition, associated with major surgery or severe medical illness. A definite diagnosis can be confirmed by elevated serum levels of C4 and C1 esterase inhibitor and C1 esterase inhibitor functional activity complement levels ( Fig. Bacterial-induced colitis, which typically persists for 1 to 2 weeks and up to 1 month, may require antibiotic treatment. Chronic perforation of the stomach complicates 1% to 3% of patients with gastric bands and results from erosion of the band into the stomach lumen. Abdominal Imaging & Emergency Radiology Radiology expert witness. Emergency Radiology is a top rated Springer Nature journal. In abdominal emergencies there is no indication of an immediate abdominal CT scan. The goal of this section is to provide an overview of the normal bowel anatomy, discuss the diagnostic approach, and describe common examples of SBO and inflammation. In some cases nonoperative treatment of sigmoid volvulus may be followed with an elective sigmoidectomy. In the case of malignant duodenal obstruction, many such cases are generally classified as causing “gastric outlet obstruction,” leading to ambiguity as to the precise level of obstruction. Toxic megacolon may be a complication of infectious colitis such as C. difficile colitis, IBD, ischemic colitis, radiation colitis, and colonic volvulus. It is typically located in the distal ileum approximately 2 feet from the ileocecal valve. Although not an emergency per se, stricture of the esophagus can cause esophageal obstruction (including impaction of food boluses as discussed earlier) and presentation to the ED. Despite overall low diagnostic accuracy and specificity, the kidney, ureter, and bladder (KUB) radiographic examination is still sometimes used as an initial imaging examination in patients with abdominal symptoms. He is recognized both locally and internationally as an engaging radiology educator. 13-38 ). To assess patterns of use of abdominal imaging in the emergency department (ED) from 1990 to 2009.We retrospectively reviewed data on adult ED patients treated between 1990 and 2009 at our university-affiliated quaternary care institution. Small bowel obstruction is suspected when multiple gas- or fluid-filled loops of dilated small bowel are present. In early disease, mucosal edema and hyperemia are encountered, and with disease progression the mucosa develops punctate ulcers that enlarge and may extend into the lamina propria. In some instances the diverticulum will extend toward the umbilicus. The epithelium regenerates between acute inflammatory attacks, resulting in the formation of pseudopolyps, usually seen in long-standing disease. The most common benign causes of colocolic intussusception are lipomas, followed by adenomatous polyps, whereas colonic adenocarcinoma is the most common malignant cause. Acute exacerbations also require emergent medical attention. Barium studies can reliably characterize benign esophageal strictures, but those with equivocal or malignant features warrant further evaluation with endoscopy. Ulcerative colitis typically affects patients between 15 and 25 years of age with women slightly more frequently affected than men. On dynamic images, fibrotic strictures appear as aperistaltic bowel segments that often demonstrate fixed mural thickening and luminal narrowing. Although the incidence of peptic ulcers has decreased since the advent of H. pylori treatment and proton pump inhibitors, they remain a potential cause for presentation to the ED. In addition, signs of obstruction may also be seen, including proximal bowel dilatation with distally collapsed loops. 13-35 ). Although colonic dilatation is nonspecific, additional imaging findings that may be identified in patients with toxic megacolon include thickened bowel wall and markedly edematous haustra. Imaging of Gastrointestinal and Abdominal Emergencies in Binge Drinking. There are no clear guidelines when or when not to request an abdominal X-ray (AXR). This section will discuss inflammation, infection, obstruction, and perforation of the esophagus, stomach, and duodenum. Although most esophageal foreign bodies pass spontaneously, 10% to 20% of cases require endoscopic removal and approximately 1% undergo surgery for treatment. Emergency Radiology presents a comprehensive review of emergency pathologies commonly encountered by practicing radiologists and residents in training. Intestinal malrotation and midgut volvulus presenting in adulthood. Available ONLY to: Possible causes of benign esophageal strictures include long-standing gastroesophageal reflux, radiation, chronic medication-induced esophagitis, nasogastric intubation, epidermolysis bullosa, and eosinophilic esophagitis. Cecal bascule refers to abnormal positioning of the cecum in the midabdomen secondary to loose mesenteric attachment, which results in folding of the cecum. This three-day course is designed to provide the practicing radiologist an intensive hands-on experience in imaging interpretation of traumatic and non-traumatic emergencies. She is tender across the lower abdomen with vague fullness. The most common cause of acute colonic obstruction is malignancy, usually occurring in the sigmoid colon ( Fig. In the setting of severe stenosis or occlusion of the mesenteric arterial or venous supply, bowel ischemia can lead to significant bowel wall thickening, resulting in SBO. Although a strict size limit for normal appendices, similar to ultrasonographic imaging, is not applicable to CT given the lack of compression, acutely inflamed appendices are typically dilated and approach or exceed 1 cm in diameter. Aphthous ulcers with a target appearance, deep fissuring ulcers, and lymphoid hyperplasia are characteristic findings on colonoscopy. Due to wide MDCT technology availability, the first-line assessment of vascular abdominal emergencies is CTA. Check for errors and try again. Duodenal peptic ulcers are more common than gastric ulcers, typically solitary, and located in the duodenal bulb in 5% to 11% of patients. Multidetector CT (MDCT) is an imaging technique that provides otherwise unobtainable information in the diagnostic work-up of patients presenting with acute abdominal pain. 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