Evaluation of submucosal lesions of the large intestine - Part 2. Nonneoplastic causes
ABSTRACT Various nonneoplastic entities may manifest as submucosal abnormalities at colorectal evaluation, and it may be difficult to distinguish between those with an intramural origin and those with an extramural origin on the basis of optical colonoscopy alone. Cross-sectional radiologic imaging, which allows evaluation of the entire bowel wall and the surrounding tissues, plays an important role in the localization and characterization of these abnormalities. However, some superficial submucosal lesions that are initially detected at computed tomographic colonography or barium enema studies may be better characterized with colonoscopy; thus, it is important to recognize the complementary uses of these diagnostic tests. In addition, modalities such as transrectal ultrasonography and magnetic resonance imaging may be useful for the identification and characterization of some abnormalities. For timely and effective management, it is especially important that submucosal neoplasms of the large intestine be accurately distinguished from nonneoplastic entities such as lymphoid polyps, vascular lesions, and cystic lesions, as well as from extracolonic abnormalities (eg, endometriosis, uterine fibroids) and normal extracolonic structures (eg, uterus, vasculature).
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ABSTRACT: The case presented involves a thirty-eight year old woman with endometriosis, who was diagnosed by laparoscopic visualization and histopathological confirmation. After one year, and while the patient was on infertility work-up, she referred to a gastroenterologist from the gynecologic clinic because of palpable bulging and nodules discovered in a pelvic exam. Colonic involvement was detected by colonoscopy and endosonography. A pathology report of sections of the colonic mucosa revealed deciduosis (endometriosis). This incidence of this type of endometriosis is quite rare, and involves extensive involvement of colonic mucosa. We recommend careful pelvic examination and rectovaginal palpation in endometriosis pa- tients even if they appear asymptomatic for gastrointestinal complications.
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ABSTRACT: Peritoneal diseases can be seen in the different imaging modalities either as fluid collections or solid tumors along the ligaments, mesenteries, and spaces of the peritoneal cavity. The broad spectrum of different abnormalities includes inflammatory, infectious, traumatic, and neoplastic diseases. In this article, a large variety of peritoneal abnormalities such as ascites, peritonitis, intraperitoneal hemorrhage, and both primary and secondary peritoneal tumors are discussed. The different imaging modalities, characteristic radiological features, and typical pathways of anatomic spread are explained.Der Radiologe 03/2009; 49(7):637-51; quiz 652-4. DOI:10.1007/s00117-008-1766-y · 0.41 Impact Factor
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ABSTRACT: Radiologic imaging of the large intestine continues to evolve and expand the potential for noninvasive diagnosis. The aim of this review is to provide an update on current and emerging clinical capabilities for a variety of radiologic diagnostic imaging tools for evaluating the colon and rectum. The utility of computed tomography for the evaluation of symptomatic inflammatory and neoplastic conditions of the colon is well established, but the clinical role of computed tomography colonography is rapidly evolving. In addition to a number of diagnostic indications, computed tomography colonography is emerging as a potential frontline colorectal screening test for cancer prevention. MRI has become increasingly valuable for rectal cancer staging and inflammatory bowel disease but has yet to gain momentum for polyp evaluation. PET imaging has been primarily utilized for oncologic indications, but also holds considerable potential for inflammatory conditions. Other imaging modalities, such as the barium enema, conventional radiography, and ultrasound, play a much more limited role. Advances in radiologic imaging of the colorectum will continue to expand the capabilities and clinical indications for noninvasive diagnosis, allowing for a greater emphasis on the complementary roles of tissue sampling and therapy with optical colonoscopy.Current opinion in gastroenterology 09/2009; 26(1):61-8. DOI:10.1097/MOG.0b013e328332b835 · 3.66 Impact Factor