Traumatic urinary bladder rupture: the usefulness of CT cystography

A 38-year-old male presented at the emergency unit with acute abdominal pain and massive hematuria after a fall in the stairs of his home. At physical examination, tenderness was found in the hypogastric area and in both right and left iliac regions. The first radiological investigation performed was ultrasonography (Fig. A). Free liquid was found in the Morisson pouch, in the perihepatic-space and in the perisplenic fossa. The bladder contained blood clots and there was no liquid in the Douglas pouch. Active bleeding was not excluded. Unenhanced and contrast-enhanced CT of the abdomen in arterial, venous and late phase was performed and large amount of intraperitoneal liquid was confirmed but without evident cause (Fig. B). There were no visceral injuries neither skeletal lesion nor vascular lesion. 60 minutes later, an additional cystography phase was performed and revealed a rupture in the superior aspect of the bladder with intraperitoneal spilling of contrast (Fig. C and D). Consequently, the patient was admitted for surgical repair of the bladder defect

Ileo-colic hernia through the foramen of Winslow

A 60-year-old woman was admitted to hospital for acute post prandial epigastric pain and vomiting

Pseudo-achalasia: a complication of laparoscopic adjustable gastric banding

A 49-year-old woman presented with dyspepsia and nocturnal regurgitation. A laparoscopic adjustable gastric binding (LAGB) had been performed 6 years before presentation. An upper gastrointestinal barium contrast study was performed and revealed a marked dilatation and tortuous course of the esophagus as well as absence of peristalsis and delayed evacuation of the esophagus (Fig. A, B). The findings were compatible with an achalasia-like disorder. An esophageal manometry revealed a constant high LES pressure with aperistalsis, thus confirming the diagnosis of (pseudo-)achalasia. Consequently a complete band deflation was conducted and resulted in a complete resolution of the patient’s symptoms. Two weeks later the control contrast study showed a marked improvement of the delayed evacuation and a small regain of peristaltic function. The dilatation and “sigmoidlike” image of the esophagus remained unchanged (Fig. C)

Unexpected pyomyositis of right buttock

A 11-year-old boy was admitted to the emergency department complaining of pain in the right hip, fever and had developed a noticeable limp sinds one week. He had fallen on his buttock in the swimming pool a few weeks before. Physical examination revealed pain at the mobilisation of the right hip, without limitation of movement. The laboratory data showed increased value CRP (154 mg/l) and leukocytosis at 11300 WBC/µl