Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE: To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS: This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS: Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION: Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19

Effects of the Use of Automatic Tube Current Modulation on Patient Dose and Image Quality in Computed Tomography

Objectives: The frequency of abdominal computed tomography examinations is increasing, leading to a significant level of patient dose. This study aims to quantify and evaluate the effects of automatic tube current modulation (ATCM) technique on patient dose and image quality in contrast-enhanced biphasic abdominal examinations

Primary versus Repeated Cytoreduction for Peritoneal Metastasis: A paired Analysis of Surgical Outcomes

Background:Cytoreductivesurgery(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) has becomethe treatment of choice for resectable peritoneal metastasis(PM) to improve theoverall survival of these patients. It’s so difficult to predict how the morbi-mortalityresults and oncologic outcomes will be in repeated CRS(re-CRS). Objectives:Toevaluate the surgical and oncologic outcomes of primary CRS&amp;HIPEC and re-CRS&amp;HIPEC.Methods: Prospectivelymaintained database of 661 PM patients treated with potentially curative intentCRS&amp;HIPEC thorough the years of 2007 and 2020 was evaluated. Re-cytoreductive surgery was performed in51 of them. Seven of these patients underwent CRS for the third time. The median age was 54 (ranging, 16-76) yearsand 72.5 % of the patients was female. The most common primaries were ovarian(39.2%)and colorectal(37.2%) tumors. The median Peritoneal Cancer Index(PCI) was 7(ranging, 3-21) and 84.3% of the patients underwent CC-0. Allstandart clinico-pathological characteristics, re-operative findings, morbi-mortalityresults, and final oncologic outcomes were reviewed and were compared with thoseof patients who had primary CRS&amp;HIPEC.Results: Themedian operating time was 300 minutes(range, 120–570) and 305 minutes(ranging,120–650) during the primary CRS and re-CRS. While less than five organs wereresected in 82.7%(n=42) of the patients who underwent primary CRS, it was84.3%(n=43) for the patients who underwent re-CRS. The median length of hospital stay(LoHS) after primaryCRS and re-CRS were 15 days(ranging, 4-48) and 12 days(ranging, 5-90), respectively.Themorbidity rates were 31.3%(n=16) and 7.8%(n=4), respectively. Thehigh grade morbidity rate was lower in re-CRS group(grade III-IV 21.5% vs 7.8%).The mortality rates were similar in between the patients who underwent primaryCRS(5.8%) and re-CRS(5.8%). When the patients who underwent CRS for the thirdtime were compared with patients who underwent re-CRS, no significantdifference was found in terms of surgical outcomes. Thepatients in the group who underwent re-CRS had significantly shorter meanhospital(LoHS)(p&lt;0.05) and lower postoperative high grademorbidity(p&lt;0.05) than the patients in the group who underwent primary CRS.The overall survival of the patients in the primary CRS group was 81.29 months,whereas it was 79.77 months in the re-CRS group. The3- and 5-year survival rates were lower in re-CRS group(17% and 5% vs 22% and11%), respectively.Conclusions: Re-CRSand HIPEC can be safely and effectively performed with acceptablemorbi-mortality results and oncologic outcomes in carefully selected andintensely followed-up PM patients at experienced centers.Key words: Repeated cytoreductive surgery, hyperthermicintraperitoneal chemotherapy, peritoneal metastasis.</p

Giant gossypiboma presenting as a pelvic mass

Gossypiboma is a foreign object, such as a mass of cotton matrix or a sponge, that is left behind in a body cavity during surgery. It is uncommon, mostly asymptomatic, and hard to diagnose. It may be incorrectly diagnosed preoperatively, which can lead to unnecessary invasive diagnostic procedures and operations. It should be included in the differential diagnosis of soft-tissue masses detected in patients with a history of a prior operation. We present a case of 36-year-old female who referred to emergency room with severe abdominal pain and distension. Imaging revealed a giant intra-abdominal mass resembling a soft tissue tumor, but revealed to be a giant gossypiboma caused by a sponge that was forgotten during previous ectopic pregnancy surgery. This case differs from others with the absence of findings supporting gossypiboma such as calcification or trapped gas bubbles and emphasizes the importance of this potentially life-threatening complication of surgery.</p

Hipertermik intraperitoneal kemoterapi ile sitoredüksiyon sonrası gastrointestinal anastomoz kaçağı için risk faktörleri

BACKGROUND: Gastrointestinal anastomotic leak (GAL) is a major cause of morbidity and mortality after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study is to determine the risk factors associated with GAL in peritoneal metastases (PM) surgery. METHODS: Patients who underwent CRS and HIPEC with gastrointestinal anastomosis were included. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status were used to assess preoperative condition of the patients. GAL was recorded as gastrointestinal extralumination diagnosed clinically, radiologicaly, or during reoperation. RESULTS: Among 362 patients who were analyzed, the median age was 54 years, 72.6% were female, and the most common histopathologies were ovarian cancer (37.8%) and colorectal (36.2%) cancer. The median Peritoneal Cancer Index was 11 and 80.1% of the patients underwent complete cytoreduction. A single anastomosis was performed in 293 (80.9%) patients, two anastomoses in 51 (14.1%) and three anastomoses in 18 (5%) patients. Diverting stoma was performed in 43 (11.8%) patients. GAL was seen in 38 (10.5%) patients. Smoking (p<0.001), ECOG performance status (p=0.014), CCI score (p=0.009), pre-operative albumin level (p=0.010), and number of resected organs (p=0.006) were significantly associated factors with GAL. Independent risk factors for GAL were smoking (Odds Radio [OR]: 6.223, confidence interval [CI]: 2.814-13.760; p<0.001), CCI score ≥7 (OR: 4.252, CI: 1.590-11.366; p=0.004), and pre-operative albumin level ≤3.5 g/dl (OR: 3.942, CI: 1.534-10.130; p=0.004). CONCLUSION: Patient-related factors such as smoking, comorbidity, and pre-operative nutritional status had an impact on anasto-motic complications. Proper patient selection and prediction of an index patient requiring a prehabilitation program with a high level of care are essential prerequisites to obtaining lower anastomotic leak rates and improving outcomes in PM surgery.AMAÇ: Gastrointestinal anastomoz kaçağı (GAK), sitoredüktif cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HİPEC) sonrası önemli bir morbidite ve mortalite nedenidir. Bu çalışmanın amacı peritoneal metastaz (PM) cerrahisinde GAK ile ilişkili risk faktörlerini belirlemektir. GEREÇ VE YÖNTEM: Çalışmaya gastrointestinal anastomozlu SRC ve HİPEK uygulanan hastalar dahil edildi. Hastaların ameliyat öncesi durumunu değerlendirmek için Charlson Komorbidite İndeksi (CCI) ve Eastern Cooperative Oncology Group (ECOG) performans durumu kullanıldı. GAK klinik, radyolojik veya yeniden ameliyat sırasında teşhis edilen gastrointestinal ekstralüminasyon olarak kaydedildi. BULGULAR: Analiz edilen 362 hastanın ortanca yaşı 54 idi. Hastaların %72.6’sı kadın ve en sık görülen histopatolojiler over kanseri (%37.8) ve kolorektal kanser (%36.2) idi. Medyan Periton Kanser İndeksi 11 idi ve hastaların %80.1’ine tam sitoredüksiyon uygulandı. İki yüz doksan üç (%80.9) hastada tek anastomoz, 51 (%14.1) hastada iki anastomoz ve 18 (%5) hastada üç anastomoz yapıldı. Kırk üç (%11.8) hastaya saptırıcı stoma uygulan-dı. Otuz sekiz (%10.5) hastada GAK görüldü. Sigara kullanımı (p<0.001), ECOG performans durumu (p=0.014), CCI skoru (p=0.009), preoperatif albümin düzeyi (p=0.010) ve rezeke edilen organ sayısı (p=0.006) GAK ile anlamlı ilişkili faktörlerdi. GAK için bağımsız risk faktörleri sigara (OR: 6.223, CI: 2.814–13.760; p<0.001), CCI skoru ≥7 (OR: 4.252, CI: 1.590–11.366; p=0.004) ve preoperatif albümin seviyesi ≤3.5 g/dl (OR: 3.942, CI: 1.534–10.130; p=0.004) idi. TARTIŞMA: Sigara kullanımı, komorbidite ve ameliyat öncesi beslenme durumu gibi hasta ile ilişkili faktörlerin anastomoz komplikasyonları üzerinde etkisi vardı. Uygun hasta seçimi ve yüksek düzeyde bakım gerektiren prehabilitasyon programı ihtiyacı olan indeks hastanın tahmini, daha düşük anastomoz kaçak oranları elde etmek ve PM cerrahisinde sonuçları iyileştirmek için temel ön koşullardır

RESİMLERLE BİR KONU: AKUT KARIN AĞRISINDA RADYOLOJİK GÖRÜNTÜLEME BULGULARI

RESİMLERLE BİR KONU: AKUT KARIN AĞRISINDA RADYOLOJİKGÖRÜNTÜLEME BULGULARI Ekrem Anıl Sarı, Serap Sarı, Abdullah Taylan, Işıl BaşaraAkın, Canan Altay, Funda Obuz Dokuz Eylül Üniversitesi Hastanesi Giriş-Amaç:‘Akut karın’, klinisyenin acil bir tedavi kararı verme[1]sinigerektiren şiddetli karın ağrısı ile karakterize klinik bir durumdur. Yaşamıtehdit eden hastalıklardan iyi huylu kendi kendini sınırlayan durumlara kadargeniş bir hastalık yelpazesini içerir. Görüntüleme yöntemleri açısından US’niniyonlaştırıcı radyasyon içermemesi ve ucuz olması avantajıdır (1,2). AmerikanRadyoloji Koleji (ACR) uy[1]gunluk kriterlerlerine göre(2018), lokalize edilemeyen karın ağrısı olan ve ateşi olan hastalar için kontrastlıBT ilk seçilmesi gereken görüntüleme yöntemidir (3). Abdominal grafi ise ürinertaş ve pnö[1]moperitonyumun tanısındayararlı olmakla birlikte grafinin normal olması ileusu veya diğer patolojileriekarte etmez (4). Bu sunumda akut karın ağrısına sebep olabilecek olgulardanbazılarını ele alıp rad[1]yolojik görüntülemebulguları sunulmuştur. Olgular Akut apandisit: Radyolojik incelemenin amacınegatif lapara[1]tomi oranını düşürmek veakut apandisiti perforasyon gelişmeden önce teşhis etmektir. US ve BT’ninönemli rolleri vardır, ancak BT’nin doğruluğu daha iyidir. Radyolojikgörüntüleme bulguları; dıştan dışa ölçülen çapın 6 mm’den fazla olması, inflameperiapendiküler yağ dokusu, apendikolit, Power Doppler’de hipervaskülariteşeklinde ta[1]riflenebilir (4) (Figür 1).Divertikülit: Radyolojik görüntüleme bulguları; divertikülosis ile birliktesegmental duvar kalınlık artışı, yağlı dokuda enflamatuar değişikliklerşeklindedir. Apse oluşumu veya perforasyon gibi diver[1]tikülitkomplikasyonları en iyi BT ile dışlanabilir. Bu konuda önemli bir tuzak; kolonkanseri özellikle invaziv büyüme gösterdiğinde, des[1]moplastikreaksiyon veya inflamasyon nedeniyle benzer görüntüle[1]meözelliklerinin ortaya çıkabilmesidir (FigürAkut Kolesistit:.US, %88 duyarlılık, %80 özgüllük ile primergörüntülemedir. Radyolojik görüntüleme bulguları intraluminal taş, kalınlaşmışkese duvarı (&gt;3 mm), perikolesistik sıvı koleksiyonu, subserozal ödem, kesedistansiyonu (&gt;4 cm), kesede çamurdur. (6) (Figür 3). İnce Barsak Obstrüksiyonu:BT,%94 duyarlılık ve %96 öz[1]güllük ile en iyigörüntüleme yöntemidir. Radyolojik görüntüleme bulguları; barsakta çapdeğişikliği olması (&gt;2.5 cm), feçes bulgusu (obstrüksiyon noktasınınbelirlenmesinde önemli) olarak özetlenebi[1]lir(Figür 4). Barsak İskemisi: Arteriyel ve venöz fazlarda bifazik kontrastlı BTtanıda en iyisidir. BT bulguları nonspesifik olabilmekle birlikte; barsak duvarkalınlık artışı (&gt;3 mm), anormal bağırsak duvarı kont[1]rastlanması,barsak duvarında aşırı incelme (yaklaşmakta olan per[1]forasyon),pnömotosis intestinalis, portal ven periferinde hava gibi bulgular görülebilir(8) (Figür 5). Rüptüre Anevrizma:BT tanıda en duyarlı ve özgül yöntemdir.Radyolojik görüntüleme bulguları; periaortik yağlı dokudada kirlen[1]me, retroperitonealhematom, IV kontrast ekstravazasyonu şeklinde özetlenebilir (9) (Figür 6).Tartışma ve Sonuç: Akut kolesistit şüphesi haricinde, BT tetkiki akut karınağrısıyla gelen hastalarda primer görüntüleme yöntemidir. Akut kolesistittanısında US tercih edilmekle birlikte, BT de kabul edilebilir biralternatiftir. Radyasyon maruziyeti, BT’nin bir dezavan[1]tajıdır.Bu yüzden US ilk tanı tetkiki olarak kullanılabilir ve tanısal ol[1]mayan sonuçlarda BT tetkikidüşünülebilir. MR görüntüleme de tanı konusunda BT’ye alternatif olma potansiyelinesahip olmakla birlikte bu konuda destekleyici verilier hala yetersizdir.Anahtar kelimeler: Abdomen, Acute, Radiology Kaynaklar 1 Fryback DG, ThornburyJR. The efficacy of diagnostic imaging. Med Decis Making 1991;11:88–94. 2.Mackenzie R, Dixon AK. Measuring the effects of imaging: an evaluativeframework. Clin Radiol 1995;50:513–518. 3. ACR appropriateness criteria, 2006.American College of Radiology Accessed October 15, 2008. 4. Kellow ZS, MacInnesM, Kurzencwyg D, etal. The role of abdominal radiography in the evaluation ofthe nontrauma emergency patient. Radiology 2008;248:887–893. 5. Ralls PW, BalfeDM, Bree RL, et al. Evaluation of acute right lower quadrant pain: AmericanCollege of Radiology—ACR appropriateness criteria. Radiology 2000;215(suppl):159 –166 6. Hirota M, Takada T, Kawarada Y, et al. Diagnosticcriteria and severity assessment of acute cholecystitis: Tokyo guidelines. JHepatobiliary Pancreat Surg 2007; 14:78–82. 7. Lazarus DE, Slywotsky C, BennettGL, Megibow AJ, Macari M. Frequency and relevance of the “small-bowel feces”sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol 2004;183:1361–1366. 8. Herbert GS, Steele SR. Acute and chronic mesenteric ischemia.Surg Clin North Am2007;87:1115–1134. 9. Abdominal Aortic Aneurysm; by WalterTan, MD, MS; Chief Editor: Eugene C Lin, MD</p