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J B Puylaert

Publications and source records attributed to J B Puylaert.

At least 37 records · Page 2Linked to original sources
PubMed1995

Percutaneous gallbladder drainage in emphysematous cholecystitis.

Emphysematous cholecystitis is a serious disorder with a high mortality and morbidity. We report successful drainage of the gallbladder in a male diabetic patient with emphysematous cholecystitis in whom surgery was considered contraindicated because of his poor cardiac status.

Aged↗
PubMed1995

Imaging and intervention in patients with acute right lower quadrant disease.

US using graded compression plays a central role in the diagnostic work-up of acute right lower quadrant disease, but its results should always be integrated with clinical data and results of other possible radiological examinations. Direct US visualization of an inflamed appendix is solid proof of appendicitis. Pitfalls are secondary enlargement in perforated peptic ulcer, caecal carcinoma or Crohn's disease. If a normal appendix is visualized in its full length, appendicitis can be excluded. However, this is rarely the case. In practice, the only means to exclude appendicitis is to demonstrate an alternative condition, which in most cases is possible by US alone. Concomitant adynamic ileus is a valuable US finding. Abscesses related to appendicitis, Crohn's disease and colonic carcinoma respond well to percutaneous drainage, which is technically possible in 95% of cases. Some of these abscesses evacuate spontaneously to neighbouring bowel. For abscesses due to caecal diverticulitis spontaneous evacuation to the caecal lumen is the rule. For indication and drainage strategy, integration of US, CT and clinical data are indispensable. The use of US in right lower quadrant disease will not only lead to a strong improvement of diagnostic accuracy, but also to better understanding of the incidence and natural course of various conditions such as abortive appendicitis, appendiceal abscess, caecal diverticulitis, bacterial ileocaecitis and right-sided segmental infarction of the omentum.

Acute Disease↗
PubMed1992

[Abdominal aortic aneurysm as incidental finding in abdominal ultrasonography].

Abdominal aortic aneurysm is a life-threatening condition, which usually remains without symptoms until rupture occurs. The only way to reduce the high mortality rate (estimated at over 80%) is elective surgery on suitable patients. Therefore the presence of such an aneurysm has to be detected. For this ultrasonography is the method of choice. We studied 4399 consecutive patients aged 50 years and older, who underwent abdominal ultrasonography for the first time. According to the recommendation of the Dutch Society for Radiodiagnostics the whole abdomen was screened. In 4026 patients (1717 men and 2309 women) the ultrasound examination was performed for non-vascular reasons. In 199 of these patients (4.9%) an abdominal aortic aneurysm was an adventitious finding (133 men (7.7%) and 66 women (2.9%)). In men aged 60 years and older it was even found in 10.2%. When abdominal ultrasonography is performed for the first time in a patient aged 50 years or older, the aorta has to be screened for presence of an aneurysm.

Abdomen↗
PubMed1992

[A patient with Salmonella aortitis].

Bacterial aortitis is a rare but serious condition. Even when treated surgically, the prognosis is poor. Prompt diagnosis is mandatory. In the absence of specific clinical signs, radiological assessment by means of ultrasound and CT is most valuable. The treatment of choice is early surgical drainage, debridement and arterial reconstruction, preferably through uncontaminated tissue combined with antibiotic therapy. We report the case of a man aged 80 with Salmonella aortitis in whom the diagnosis of bacterial aortitis was made by means of ultrasound and CT, following which successful intervention was carried out.

Aged↗
PubMed1992

Eosinophilic enteritis presenting as acute abdomen: US features of two cases.

Eosinophilic enteritis is a rare disease which may mimic acute abdominal emergency. Two sonographically documented cases are presented, which were subsequently proven at operation. Although the sonographic features of severe echolucent bowel wall thickening were not specific, combination with clinical and laboratory data may suggest the correct diagnosis.

Abdomen, Acute↗
PubMed1992

Right-sided segmental infarction of the omentum: clinical, US, and CT findings.

Clinical, ultrasound (US), and computed tomographic (CT) findings at hospital admission and follow-up were retrospectively studied in seven patients with right-sided segmental infarction of the omentum. In all patients, the presumptive clinical diagnosis was appendicitis, although in three patients cholecystitis and pyelitis were also considered. US revealed an ovoid or cakelike, moderately hyperechoic, noncompressible lesion adherent to the peritoneum and located at the level of the umbilicus, anterolateral to the right half of the colon. On CT scans, a corresponding, better defined area of fat interspersed with hyperattenuating streaks was found. No abnormality of bowel or appendix was seen. The clinical symptoms and abnormalities on US scans gradually disappeared in all patients. Because no patient underwent surgery, no histologic proof was obtained. In all patients, however, the clinical, US, and CT findings were similar and consistent. They corresponded to the abnormality called right-sided segmental omental infarction in the surgery and radiology literature and enabled exclusion of appendicitis, thus preventing unnecessary surgery.

Adolescent↗
PubMed1991

[Bacterial ileocecitis, a "new" disease].

786 patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish appendicitis from bacterial enteritis. 533 of these patients were described before. In 91 (11.6%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region-enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of an inflamed appendix. In 64 of these a bacterial infection was confirmed (Yersinia enterocolitica in 28, Campylobacter jejuni in 24, Salmonella enteritidis in 11, Yersinia pseudotuberculosis in one). In the other 27, bacteriological tests were negative (17) or not performed (10). Only 34 of 91 had diarrhoea. Six of the 91 patients underwent surgery, in all of them the removed appendix was normal. The other 85 patients recovered with conservative treatment. In 38 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocecitis) appears to be responsible for an appreciable number of unnecessary appendicectomies. It has characteristic sonographic features which distinguish it from appendicitis.

Adolescent↗
PubMed1991

Ultrasonography in the diagnosis of acute appendicitis.

Ultrasonography with graded compression was performed in 525 patients with clinical signs of acute appendicitis. Of 207 patients with surgically proven appendicitis the inflamed appendix (diameter greater than or equal to 6 mm) had been visualized sonographically in 177 (86 per cent). The score for non-perforated appendicitis (91 per cent) was higher than for perforated appendicitis (55 per cent). Twenty-four patients in whom an inflamed appendix was seen on ultrasonography did not undergo surgery because of rapidly subsiding symptoms ('abortive appendicitis'). Four of these 24 developed recurrent appendicitis warranting surgery. Two underwent elective appendectomy and 18 have remained symptom-free. Of 155 patients with a subsequently confirmed alternative condition, ultrasonography made the correct diagnosis in 140: bacterial ileocaecitis (69), mesenteric lymphadenitis (eight), gynaecological conditions (34), urological conditions (eight), caecal diverticulitis (six), perforated peptic ulcer (six), Crohn's disease (two) and miscellaneous conditions (seven). Of 139 patients in whom no definite diagnosis was made ultrasonography showed no abnormalities in 138. In four patients a false positive sonographic diagnosis of appendicitis was made and in two patients with appendicitis an alternative condition was incorrectly diagnosed. During the last 3 years of the study the negative appendicectomy rate was 7 per cent and delay beyond 6 h after admission occurred in only 2 per cent of patients with surgically proven appendicitis. When used to complement the clinical diagnosis ultrasonography improves the diagnostic accuracy and patient management in those suspected of having acute appendicitis.

Acute Disease↗