Metallic stent placement in patients with acute colonic obstruction was a minimally invasive and cost-effective preoperative procedure that allowed single-stage surgery in most cases. Stent placement for palliation should be limited to patient with special indications.
Purpose: To assess primarily the feasibility of magnetic resonance imaging (MRI) as a tool to monitor small bowel peristaltic motion and secondarily to validate this technique by demonstrating drug-induced motility changes.
Materials and Methods:After a standardized oral preparation of Ispaghula husk (Metamucil ) and meglumine gadoterate (Gd-DOTA; Dotarem ), 10 volunteers underwent dynamic MRI using a two-dimensional turbofast field echo (TFE) sequence with a slice repetition time of 500 msec. Intraluminal cross-sectional caliber changes over time were assessed allowing quantification of the peristaltic frequencies and amplitudes of the small gut on various regions of interest. Pharmacologically induced alterations of the peristaltic motion after spasmolytics and gastrokinetic motion enhancers were investigated.Results: Small bowel diameter measurement resulted in a peristalsis of 10.96 (SD ϭ Ϯ2.51) waves per minute, oscillating regularly with mean amplitudes of 6.65 mm (SD ϭ Ϯ1.15 mm). Peristaltic frequency in normal individuals is consistent with that observed with other techniques. Intravenous administration of scopolamine butylbromide (ϭ hyoscine butylbromide/Buscopan ) resulted in small bowel paralysis within 21.3 seconds (SD ϭ Ϯ2.8 seconds). Prokinetic effect of intravenous metoclopramide (Paspertin ) after Buscopan paralysis was tested in one volunteer, characterized by a slow recovery of peristalsis, which propagated from the proximal to the distal segments and enhanced contraction amplitudes.
Conclusion:Dynamic MRI allows observing and quantifying small bowel peristalsis, characterizing motion patterns, and monitoring the effects of interfering factors such as drugs.
Seven cases of esophageal intramural pseudodiverticulosis (EIPD) are presented and compared with 46 cases previously reported. EIPD is mainly a disease of older age with a 3:2 predominance of male patients. The radiologic appearance of EIPD shows great variation in localization and severity of visible changes. Radiologic examination is far more sensitive than endoscopy in diagnosing EIPD. The most effective therapy for EIPD is dilatation of strictures, leading to amelioration or disappearance of symptoms in over 90% of cases. Visible pseudodiverticula may persist after therapy, even in symptom-free patients.
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