Computed Tomography Evaluation of Gastrointestinal Bleeding and Acute Mesenteric Ischemia
University of Ulsan, Urusan, Ulsan, South KoreaRadiologic Clinics of North America (Impact Factor: 1.98). 01/2013; 51(1):29-43. DOI: 10.1016/j.rcl.2012.09.003
Gastrointestinal bleeding and acute mesenteric ischemia are conditions that generally require an urgent and accurate diagnosis. In this setting, multidetector computed tomography (MDCT) can play an important role. This article discusses current techniques, the findings in correlation with pathophysiology, and the proper use of MDCT in the diagnostic evaluation and management of these patients.
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ABSTRACT: It is difficult to diagnose small bowel bleeding because the small intestine is overlapping, redundancy with unfixed location, and with peristalsis constantly, as well as inspection methods are limited. Multi-slice CT (MSCT), multi-slice CT enteroclysis (MSCTE) and post-processing technology became more mature and developed in recent years, which bestowed great value for the diagnosis of small bowel bleeding. This article reviewed the value of MSCT in the diagnosis of small bowel bleeding.
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ABSTRACT: Damage control surgery is a management sequence initiated to reduce the risk of death in severely injured patients presenting with physiological derangement. Damage control principles have emerged as an approach in non-trauma abdominal emergencies in order to reduce mortality compared with primary definitive surgery. A PubMed/MEDLINE literature review was conducted of data available over the past decade (up to August 2013) to gain information on current understanding of damage control surgery for abdominal surgical emergencies. Future directions for research are discussed. Damage control surgery facilitates a strategy for life-saving intervention for critically ill patients by abbreviated laparotomy with subsequent reoperation for delayed definitive repair after physiological resuscitation. The six-phase strategy (including damage control resuscitation in phase 0) is similar to that for severely injured patients, although non-trauma indications include shock from uncontrolled haemorrhage or sepsis. Minimal evidence exists to validate the benefit of damage control surgery in general surgical abdominal emergencies. The collective published experience over the past decade is limited to 16 studies including a total of 455 (range 3-99) patients, of which the majority are retrospective case series. However, the concept has widespread acceptance by emergency surgeons, and appears a logical extension from pathophysiological principles in trauma to haemorrhage and sepsis. The benefits of this strategy depend on careful patient selection. Damage control surgery has been performed for a wide range of indications, but most frequently for uncontrolled bleeding during elective surgery, haemorrhage from complicated gastroduodenal ulcer disease, generalized peritonitis, acute mesenteric ischaemia and other sources of intra-abdominal sepsis. Damage control surgery is employed in a wide range of abdominal emergencies and is an increasingly recognized life-saving tactic in emergency surgery performed on physiologically deranged patients.
Article: CT Enterography[Show abstract] [Hide abstract]
ABSTRACT: CT enterography (CTE) has become a key component for the diagnosis and management of small intestinal diseases and lesions. As a radiologic modality designed to optimize visualization of the small bowel and surrounding structures, it can be utilized for an extremely diverse set of indications. CTE in adult and pediatric Crohn’s disease patients can detect active inflammation, stricturing disease, and penetrating complications, and assess response to medical therapy. It can also demonstrate extraintestinal inflammatory bowel disease manifestations and alternate etiologies for a patient’s symptoms of abdominal pain or diarrhea. Additional CTE applications include the diagnosis of small bowel tumors and vascular lesions in patients with obscure gastrointestinal bleeding. These features have made CTE a vital tool in the clinician’s small bowel imaging armamentarium.
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