Pneumatosis intestinalis (PI) and pneumoperitoneum are commonly recognized as severe signs of gastrointestinal diseases that require emergency surgery. However, these symptoms can also be caused by benign conditions. We describe 4 cases of benign PI and pneumoperitoneum that were detected in different clinical situations (accidental discovery in bilan of aortic dissection (case #1), bilateral pulmonary embolism (case #2), overflow diarrhea due to fecal impaction (case #3), and in follow-up postbiliary digestive anastomosis surgery (case #4), which were addressed with exploratory surgery (case #1) or conservative treatment (the remaining cases), with favorable outcomes. Because PI and pneumoperitoneum can be associated with both life-threatening causes and benign conditions, treatment decisions should be based on the correspondence between clinical and paraclinical features, rather than imaging alone
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Background: Spinal cord ischemia is a major complication of treatment for descending thoracic aorta (DTA) disease. Our objectives were (1) to describe the value of angiographic cone-beam CT (angio-CBCT) and 3D road-mapping to visualize the Adamkiewicz artery (AA) and its feeding artery and (2) to evaluate the impact of AA localization on the patient surgical strategy. Methods: Between 2018 and 2020, all patients referred to our institution for a surgical DTA disorder underwent a dedicated AA evaluation by angio-CBCT. If the AA feeding artery was not depicted on angio-CBCT, selective artery catheterization was performed, guided by 3D road-mapping. Intervention modifications, based on AA location and one month of neurologic follow-up after surgery, were recorded. Results: Twenty-one patients were enrolled. AA was assessable in 100% of patients and in 15 (71%) with angio-CBCT alone. Among them, 10 patients needed 3D road-mapping-guided DSA angiography to visualize the AA feeding artery. The amount of contrast media, irradiation dose, and intervention length were not significantly different whether the AA was assessable or not by angio-CBCT. AA feeding artery localization led to surgical sketch modification for 11 patients. Conclusions: Angio-CBCT is an efficient method for AA localization in the surgical planning of DTA disorders.
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