Typical morphologic changes include diffuse bowel wall thickening, strictures and fistula formation, tethering, and impaired peristalsis. The vascular supply of the small and large bowel is supplied by the celiac trunk, which provides the blood supply from the distal esophagus to the descending duodenum; the SMA, which supplies the distal duodenum, jejunum, ileum, and the large bowel to the splenic flexure; and the inferior mesenteric artery (IMA), which supplies the more distal colon. Iatrogenic SBO can occur as a result of endoscopic capsule retention because they have been used more often in the evaluation of the small bowel, particularly in patients with CD. The inflamed and edematous appendix is dilated and fluid filled and exhibits surrounding periappendiceal edema and fat inflammation ( Fig. The increasing rate of obesity in the United States has resulted in a rising number of bariatric surgery techniques, one of which is gastric banding. The gastric antrum demonstrates a thicker wall on CT and can normally demonstrate mural stratification, owing to its greater muscular composition and increased peristalsis in this segment. Although the diagnosis is often suspected based on clinical history, CT has become the primary modality in evaluation and management of patients with suspected bowel obstruction. 13-12 ). Ultrasound in Abdominal Emergencies Dr/Ahmed Bahnassy Consultant Radiologist Riyadh Military Hospital 2. Thumbprinting, nodules, inflammatory polyps, and ulcers are additional findings that may be identified in cases of infectious colitis on barium enema. He has taught abdominal and emergency imaging at several national and international courses and has a particular passion for delivering radiology education using social media and new technology. This conglomerate of findings should prompt a search for an adjacent hyperenhancing nodule representing a gastrinoma, although these may be difficult to identify on routine portal venous phase CT and may require multiphase phase CT, endoscopic ultrasonography (EUS), or octreotide scan to aid in detection. The upright view of the chest is best for the detection of free air under the diaphragm (pneumoperitoneum), which is an ominous sign of bowel perforation. Herpes esophagitis typically presents with multiple small ulcers represented by pooled barium. Importantly, the location of the abdominal pain varies depending on the segment of colon that is affected. Intraluminal rugal folds in the stomach are most prominent in the gastric fundus and body. MECCSIG Members. The 'acute abdomen' is a clinical condition characterized by severe abdominal pain, requiring the clinician to make an urgent therapeutic decision. 13-51 ). Four major forms of intussusception have been described, including enteroenteric, ileocolic, ileocecal, and colocolic. It is a C-shaped structure that extends to the ligament of Treitz. Special Section: Distinguished reports from the Japanese Society of Abdominal Radiology (JSAR) June 2017, issue 6; May 2017, issue 5; April 2017, issue 4. 13-3 ). Marked abdominal tenderness to palpation with significant rebound tenderness is elicited on physical examination. 13-2 ). Patients who have undergone organ transplantation also have an increased risk for developing bezoars, which is hypothesized to be secondary to decreased gastric motility, either due to vagus nerve injury or a side effect of cyclosporine. Fistulas, sinus formation, and abscesses are features of penetrating disease. Complications of Salmonella infection include bowel perforation, toxic megacolon, gangrenous cholecystitis, and massive lower GI bleeding. A false diagnosis of colonic obstruction, particularly in patients with obstructive symptoms, may lead to inappropriate surgical exploration. Special Section on Dual Energy CT. February 2017, issue 2. In early disease, mucosal edema and hyperemia are encountered, and with disease progression the mucosa develops punctate ulcers that enlarge and may extend into the lamina propria. The false lumen of esophageal dissection is often posterior to the true lumen and may be better demonstrated on coronal and sagittal reformatted images. MCQs reviewing important topics related to abdominal emergencies which are commonly asked in NEET PG/ AIIMS exams. On CT, acute appendicitis is seen as a distended, circumferentially thickened, fluid-filled structure with mucosal hyperenhancement and surrounding fat stranding consistent with periappendiceal inflammation ( Fig. The imaging features of the “Rigler triad” include SBO, an ectopic gallstone, and pneumobilia because a cholecystenteric fistula is needed for the migration of a large obstructing gallstone to occur ( Fig. The focus of your assessment process will be to accurately perform a physical examination and SAMPLE history to describe the condition and identify potentially serious conditions such as shockPatients present with obstructive symptoms of abdominal pain and distention, nausea, vomiting, and failure to pass stool. Note that the band has extraluminal gas surrounding it. In cases of suspected acute appendicitis in pregnant women, an abdominal US is often the initial imaging study obtained to evaluate for possible appendicitis. 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