Peut-on distinguer en tomodensitométrie une occlusion du grêle par bride d une occlusion du grêle par adhérences ?

Objectifs. Déterminer l'existence de critères tomodensitométriques permettant de différencier l'origine par bride ou par adhérences d une occlusion aigue du grêle. Matériel et méthodes. 70 patients avec une suspicion clinique d occlusion aigue du grêle ont été inclus et explorés en tomodensitométrie. 57 patients (30 femmes et 27 hommes), d âge moyen 63 ans étaient suspect d une origine par bride ou par adhérences. Les données recueillies étaient: la présence d une zone jonctionnelle nette et son caractère unique ou multiple, la présence d un whirl sign, d un signe du bec, d un feces sign, d un accolement des anses digestives à la paroi abdominale antérieure et la présence de signes de souffrance digestive. La référence diagnostique était la chirurgie (n=33) ou le suivi clinique sur plus de 6 mois (n=24). Résultats. L'accolement des anses grêles à la paroi antérieure était le signe le plus évocateur d'adhérences (Se=90%, Sp=70%, PD=77 ,2%, p<0.05). Pour le mécanisme par bride, la présence d'un whirl sign était très sensible (86%) et spécifique (82%) avec une PD de 84%; le signe du bec et l'existence d'une zone jonctionnelle nette et unique étaient très sensibles (respectivement 100 et 95%) mais moins spécifiques (respectivement 68 et 36%). Les concordances entre le diagnostic du radiologue et la référence étaient bonnes tant pour le diagnostic d'adhérences (kappa de 0.67) que pour celui de bride (kappa de 0.75). Conclusion. La présence de certains critères tomodensitométriques permet d'orienter vers le mécanisme par bride ou par adhérences d'une occlusion du grêle et donc de guider efficacement la prise en charge thérapeutique.ANGERS-BU Médecine-Pharmacie (490072105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intérêt des critères de Vittel, en complément de l examen clinique, pour l indication de réalisation d un scanner corps entier chez le patient traumatisé grave

ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Occlusion sur bride d'une anse en Y après duodénopancréatectomie céphalique : une cause rare d'angiocholite

International audienc

Prospective evaluation of the quality of laparoscopic sigmoid resection for diverticular disease.

BACKGROUND/AIMS: There were no studies comparing whether the same principles as those in conventional surgery have been applied to the laparoscopic procedure. The aim of this study was to compare the quality of open sigmoid colectomy (OSC) with laparoscopic sigmoid colectomy (LSC) for diverticular disease. Specific measurements made were of the level of anastomosis from sacral promontory, distance from anal verge, specimen length and recurrence rates. METHODOLOGY: Comparison was made between 72 consecutive patients who underwent an elective LSC to a control group of 22 patients who had previously undergone an OSC in the same institution. All patients had proctoscopy to measure the distance from the anal verge. A computed tomography without injection of contrast medium was performed in all cases to measure the distance from the sacral promontory to the top of the staple row. Length of fresh resected specimen and recurrence rates of diverticulitis were used for comparison. RESULTS: There was no statistical difference between the two groups in terms of distance of anastomosis from anal verge (p=0.78) and distance from sacral promontory (p=0.65) in LSC and OSC patients respectively. Specimen length was more extensive in the OSC group than in the LSC group (p=0.02). After a mean follow-up of 43.5 (+/- 14.8) months in the LSC group and 62.4 (+/- 7.4) months in the OSC group, there was no difference in recurrent attack\u27s rates of diverticulitis. CONCLUSIONS: This study suggested that laparoscopic procedure applied the same principles as those used in conventional surgery

Assessment of water enema computed tomography: an effective imaging technique for the diagnosis of colon cancer : Colon cancer: computed tomography using a water enema.

International audienceAIM: The aim of this study was to assess the accuracy of water enema computed tomography (WECT) for the diagnosis of colon cancer. METHODS: A total of 191 patients referred for clinically suspected colon cancer were prospectively evaluated by WECT in a multicenter trial. Examination was contrast enhanced helical CT after colon filling through a rectal tube. For all the cases, final diagnosis was obtained by colonoscopy and/or surgery. CT data were interpreted both locally and at a centralized site by a specialized and general radiologist. RESULTS: Seventy-one patients were diagnosed with colon cancer. Overall, WECT sensitivity and specificity were 98.6 and 95.0%, respectively. Positive and negative predictive values were 92.1 and 99.1%, respectively. In a subgroup of 33 patients with unclean bowel, the sensitivity and specificity of WECT were 95.0 and 92.3%, respectively. The correlation between local radiologists and the specialized radiologist was excellent (Kappa = 0.87) as was the correlation between the general radiologist and the specialist (Kappa = 0.92). CONCLUSION: This prospective analysis demonstrates that WECT is an effective, safe, and simple imaging technique for the diagnosis of colon cancer and can be proposed when a strong clinical suspicion of colon cancer is present, especially in frail patients