Biomedical subjects
Publications and source records attributed to P Fouque.
Recent advances of cross sectional imaging allow optimal evaluation of the small bowel. This chapter will detail technical considerations and emphasize the role of imaging in the evaluation of the most common diseases of the small bowel.
Advances in the understanding of bowel appearances with high-resolution sonography have led to consideration of this technique as an important tool for bowel disease assessment. Ultrasonography may display the transformation of the intestinal wall from normal to pathological state in inflammatory diseases. Furthermore, intestinal ultrasonography may serve as a diagnostic clue if typical patterns of the bowel wall are demonstrated. Thus, Crohn's disease, ulcerative colitis, diverticulitis, or infectious ileocolitis may be specifically demonstrated in the majority of cases. Besides showing the parietal signs of inflammation, ultrasonography also shows the perigut abnormalities and may demonstrate complications such as fistulas and abscesses. Finally, with the help of Doppler, some additional information may be obtained about the activity of chronic inflammatory diseases. In clinical practice, used in combination with other imaging modalities, such as CT or endoscopy, bowel ultrasonography appears to be a non-invasive and effective diagnostic tool for the diagnosis and follow-up of Crohn's disease and ulcerative colitis.
STUDY AIM: The aim of this prospective descriptive study was to evaluate the accuracy of abdomino-pelvic ultrasonography in suspected acute appendicitis in adults. PATIENTS AND METHODS: From March to July 1998, 100 consecutive patients, 63 women, 37 men (mean age: 25 years), after examination by a visceral surgeon for suspected acute appendicitis, had an abdominal ultrasonography (US) examination with high frequency transducer (7.5 to 9 MHz). The US examination concerned appendice, periappendicular tissues and neighbouring organs. The US data were correlated with the histopathologic findings in operated on patients, and with the clinical and biological follow up in non operated patients. RESULTS: Fourty-seven patients had acute appendicitis; 53 were operated on and 47 non operated. Analysis of US data revealed sensitivity 91.5%, specificity 94.3%, positive predictive value 93.5%, negative predictive value 94.3%, accuracy 93%; 75% of the other diagnosis were found by US. CONCLUSION: Systematic abdominal ultrasonography in suspected acute appendicitis is recommended in adults.
Two patients have been diagnosed preoperatively with ectopic pancreas located within the small bowel using CT-enteroclysis. This technique, combining helical CT and small bowel opacification through a naso-jejunal tube, allows detection of small tumors.
Congenital gastrointestinal duplications are uncommonly diagnosed in adult patients, and generally present as a cystic or occasionally tubular malformation. The duplication is composed of a smooth muscle wall continuous with the muscle layer of the intestinal wall and an inner mucosal lining. From December 1988 to May 1994, five patients were operated for gastrointestinal tract duplications [esophageal (1), gastric (2), duodenal (2)]. Duplications were symptomatic in three patients, and discovered incidentally in the other two. The diagnosis was established by ultrasonography (3 patients) and computed tomography (one patient). One female presented an adenocarcinoma arising in an esophageal duplication and died one year after surgical resection. Because of potential malignant transformation, these malformations must be resected. Preoperative diagnosis is important for conservative resection, except in the presence of malignancy when resection must be curative.
We studied 33 patients with acute abdominal trauma, hepatic lesions and intraperitoneal hemorrhage. No surgical attitude was adopted, analyzing the CT appearance of the intraparenchymal lesions as well as the associated hemoperitoneum. One of the patients who had suffered left hepatic laceration did not have a good evolution. The most frequent lesions were intraparenchymal hematoma, lobar lacerations and subcapsular hematoma. In two cases, drainage of the intrahepatic collections were needed. The presence of hemoperitoneum was not an indication for emergency surgery. These results confirm the present tendency of conservative management with clinical, CT and ultrasound control of the different hepatic injuries, when the patients are hemodynamically stable.
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Among 67 blunt hepatic traumas treated during a 4 years period, 34 required an emergency surgery for reasons of severe bleeding, with 16 deaths of which 11 were directly due to the liver injury. 33 patients, whose hemodynamic stability contrasted with major hepatic lesions (5 deep fractures, 28 central hematomas combined with 5 subcapsular hematomas and 3 multiple parenchymatous fractures), were subjected to nonoperative management. One patient died from sudden hemorrhage and a second one underwent further drainage for a residual pelvic abscess. In the 32 alive patients, a close watch over with ultrasound and CT scan gave prominence to a complete disappearance of the lesions within 4 to 24 weeks. The nonoperative management of such hepatic injuries may be a safe and reasonable alternative to a high risk surgery, as far as the hemodynamic condition or associated visceral lesions do not require an emergency surgery.
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73 patients on artificial ventilation and presenting with localised or diffuse consolidation had broncho-alveolar lavage (LBA), in search for a causative organism, in a prospective fashion. LBA was done using a supple balloon catheter (LBA-c) which was placed blind down the intubation tube, until a distal bronchus was blocked (under radiographic control). The mean number of organisms found was 1.56 +/- 1.2. LBA-c alone provided a diagnosis in 31 cases (42%) and in association with blood cultures in 14 cases (19%). In 11 cases (15%) the consolidation was not caused by infection. In 14 cases (19%) the diagnosis was made by serology or blood cultures alone. Finally in 8 cases (11%) no diagnosis could be made. Thus LBA-c achieved an etiological diagnosis for the pneumonia in 45 cases (54.8%) and remained negative in non-infectious cases. The good tolerance of the technique as regards blood gases, its simplicity of operation (without a fibrescope) and its diagnostic reproducibility make LBA-c an option in the diagnosis of pneumonias on artificial ventilation.
We present the radiological findings of gastric and duodenal duplications in four adults, in whom abdominal ultrasound, endoscopic ultrasound (EUS), and CT were primarily used for diagnosis. The diagnosis was surgically confirmed in all cases. Preoperative diagnosis of duplications was possible with ultrasound in three patients, in whom CT showed a nonspecific cystic structure. Ultrasound demonstrated a pathognomonic multilayered wall appearance suggestive of a digestive origin, including an echogenic inner mucosal layer and a hypoechoic muscular layer, better appreciated using EUS in one patient. In one case, digestive origin was confirmed by direct visualization of a peristaltic activity within the cystic wall after water ingestion. In the last patient, a non-specific heterogeneous mainly solid mass of the esophagogastric junction was found to be an adenocarcinoma arising from a duplication on the histological analysis of the surgical specimen.