Preface: diagnostic imaging for the general surgeon (original) (raw)
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Imaging the postoperative patient: long-term complications of gastrointestinal surgery
Insights into Imaging, 2015
Objectives The objectives of this review are (1) to become acquainted with the long-term complications of surgery of the gastrointestinal tract, and (2) to appreciate the appropriate use of imaging in the assessment of long-term complications. Background Gastrointestinal tract surgery comprises a group of procedures performed for a variety of both benign and malignant diseases. In the late postoperative setting, adhesions and internal hernias are the most important complications. and they can be further complicated by volvulus and ischemia. At present, computed tomography (CT) is the workhorse for evaluating late postoperative complications. Accurate imaging assessment of patients is essential for adequate treatment planning. Imaging findings or procedure details In this pictorial essay we will review the most frequent long-term complications after gastrointestinal surgery, including adhesions, afferent loop syndrome, closed-loop obstruction, strangulated obstruction, internal hernias, external hernias, anastomotic strictures and disease recurrence. Examples will be depicted using iconography from the authors' imaging department. Conclusions Knowledge of the most frequent complications after gastrointestinal surgery in the late postoperative period is of paramount importance for every radiologist, so that potentially life-threatening situations can be promptly diagnosed and adequate therapy can be planned. Teaching points • Long-term postoperative complications of gastrointestinal tract surgery can be divided into procedure-related and disease-related categories. • The most common procedure-related complications are internal hernias and adhesions. • The most frequent disease-related complications are mainly associated with neoplastic or inflammatory recurrence. • Computed tomography is the most useful examination when such complications are suspected.
Computed tomography: A valuable aid to the abdominal surgeon
The American Journal of Surgery, 1977
Case Reports Case I. A fifty-six year old woman with epigastric pain and malaise and 50 pound (22.7 kg) weight loss had a large 15 X 20 cm right upper quadrant abdominal mass. A laparotomy was performed and a diagnosis of hepatoma made by biopsy. The lesion involved the entire right lobe and questionably a portion of the left lobe of the liver as well. She was transferred to the Cleveland Clinic Hospital in February 1976 where selective angiography revealed a large tumor arising in the right lobe of the liver. CT revealed the lesion in cross section to be confined to the right lobe and a right hepatic lobectomy was performed. (Figures 2Ac.1 Case II. A thirty-nine year old man was referred to the Cleveland Clinic in May 1975 because of crampy abdominal pain, flushing, diarrhea, and hepatomegaly. A diagnosis of Figure I, A normal CTscan of the upper abdomen. The liver (L), pancreas (P), aorta (A), and kidney (K) are demonstrated.
Imaging evaluation of post pancreatic surgery
European Journal of Radiology, 2005
The role of several imaging techniques in patients submitted to pancreatic surgery with special emphasis to single-slice helical computed tomography (CT) and multidetector-row CT (MDCT) was reviewed. Several surgical options may be performed such as Whipple procedure, distal pancreatectomy, central pancreatectomy, and total pancreatectomy.
Best Practice & Research Clinical Obstetrics & Gynaecology, 2013
Intraoperative image is a rapidly expanding field encompassing many applications that use a multitude of technologies. Some of the these applications have been in use for many years and are firmly embedded in, and indispensable to, clinical practice (e.g. the use of X-ray to locate foreign bodies during surgery or oocyte retrieval under ultrasound guidance. In others, the application may have been in use in one discipline but not yet fully explored in another. Examples include the use of intraoperative ultrasound with or without contrast enhancement for the detection of hepatic metastases not identified preoperatively, and the effect of such additional information on the ultimate operative procedure. Intraoperative identification of sentinel lymph nodes has been explored in many specialties to a varying extent, with the aim of fine tuning and avoiding unnecessary surgery. In both these instances, we do not know the long-term effect of these interventions on patient survival or quality of life. In this chapter, we will explore the available evidence on these applications and current advances in the new technology in general, with a specific focus on gynaecology.
The Postoperative Pancreas Imaging
Journal of Gastrointestinal and Abdominal Radiology, 2020
Recent advances in the surgical techniques and postoperative intensive care have led to a decrease in the mortality rates after major pancreatic procedures, which now ranges from 1 to 3%. However, the morbidity rates are still high, resulting in longer hospital stays and greater cost. Imaging plays a fundamental role in the postoperative assessment. Specially, multidetector computed tomography scans (MDCT) is the modality of choice in the postoperative settings. Early diagnosis of the postoperative complications and differentiating them from being normal or expected postoperative findings is crucial to offer the best possible care for patients and to decrease the morbidity and mortality associated with surgery. In this article, we will briefly review the normal pancreatic anatomy, discuss the main types of pancreatic surgeries, and illustrate the imaging findings during the early postoperative period and of the main postsurgical complications in both acute and chronic postoperative ...
Imaging Features of Post Main Hepatectomy Complications: The Radiologist Challenging
Diagnostics
In the recent years, the number of liver resections has seen an impressive growth. Usually, hepatic resections remain the treatment of various liver diseases, such as malignant tumors, benign tumors, hydatid disease, and abscesses. Despite technical advancements and tremendous experience in the field of liver resection of specialized centers, there are moderately high rates of postoperative morbidity and mortality, especially in high-risk and older patient populations. Although ultrasonography is usually the first-line imaging examination for postoperative complications, Computed Tomography (CT) is the imaging tool of choice in emergency settings due to its capability to assess the whole body in a few seconds and detect all possible complications. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for delineating early postoperative bile duct injuries and ischemic cholangitis that may arise in the late postoperative phase. Moreover, both MDCT and MR...
Clinics in diagnostic imaging (176)
Singapore Medical Journal, 2017
A 52-year-old man presented to the emergency department with progressively worsening upper abdominal pain of one week's duration. He was a heavy smoker with a history of chronic heart disease and atrial fibrillation, but was not compliant with his warfarin therapy. An echocardiogram performed two months before had shown a thrombus in the left ventricular apex and left atrial appendage. The patient's vital signs included a heart rate of 122 beats per minute (irregularly irregular), blood pressure of 123/68 mmHg, respiratory rate of 20 breaths per minute and oxygen saturation of 99% on room air. He was afebrile, alert and showed no signs of distress. Pertinent physical findings included a soft abdomen with moderate tenderness elicited in the epigastrium and left hypochondrium. There was no rebound tenderness, guarding or abdominal distension. Bowel sounds were present. The remainder of the physical examination was non-contributory. Bedsidefocused ultrasonography showed no evidence of free fluid. Initial laboratory results showed a mildly raised white blood cell count of 10.4 × 10 9 /L and serum lactate level of 2.4 mmol/L (normal range 0.5-2.2 mmol/L). The patient's liver function test results were mostly within normal limits (alanine aminotransferase 12 U/L, aspartate aminotransferase 21 U/L, bilirubin 24 µmol/L, alkaline phosphatase 97 U/L), with the exception of mildly raised gamma-glutamyl transpeptidase (GGT) (61 U/L, normal range 7-50 U/L). His international normalised ratio was normal, measuring 1.2. Contrast-enhanced computed tomography (CT) of the abdomen was performed shortly after the patient was admitted. What do the CT images (Figs. 1-3) show? What is the diagnosis? CMEArticle
Case Review: Vascular and Interventional Imaging
American Journal of Roentgenology, 2005
Imaging, a volume in the Case Review Series, is a concise reference guide to interventional radiology. The authors faced a formidable task of compiling a thorough overview of the various conditions and their treatments that comprise the field. They have succeeded in creating a succinct and easily readable text with clear pictures that will assist the resident and interventional fellow in acquiring an excellent source of knowledge as well as provide the practicing radiologist with an excellent text for review.