Adenocarcinoma of the bowel is a dreadful sequelae of inflammatory bowel disease that can be difficult to diagnose and has been shown to have poor prognosis. The diagnosis is often made on histopathological examination of the resected specimen for what is suspected to be an exacerbation of the underlying intestinal Crohn’s. A 39-year-old woman who was being treated for small bowel Crohn’s disease for 4 years presented with features of intermittent intestinal obstruction that was refractory to medical therapy. A contrast CT of the abdomen was suggestive of ileocaecal Crohn’s disease, and colonoscopy revealed a stricture at proximal transverse colon with multiple superficial ulcers. She underwent a mesentery sparing right hemicolectomy and had an uneventful recovery. The biopsy, however, was reported to be moderately differentiated adenocarcinoma stage T3N0 with a harvest of four pericolic nodes. Adjuvant chemotherapy was advised, which she deferred. Ten months later, she presented to the emergency room with features of intestinal obstruction. Contrast CT of the abdomen showed thickening at the anastomotic site with intestinal obstruction. On exploratory laparotomy, tumour recurrence was noted at the site of the anastomosis and diffuse peritoneal metastasis. A palliative diversion ileostomy was done due to inoperable obstructing disease. She was then given palliative therapy and subsequently succumbed to the illness. The inclusion of mesentery with the resected specimen in Crohn’s disease has been a debate over many years. Since the preoperative diagnosis of carcinoma of the bowel in Crohn’s disease is challenging, all ileocolic resections should be radical as done in oncological resections. This would yield better oncological safety and may improve survival rates.
Introduction: There is a significant degree of anatomical variation at the level of the sphenoid sinus and sella turcica and a wide range of these values have been reported in literature and ethnic variation has also been found to contribute to this. Thus preoperative imaging of the central skull base with a knowledge of the normal anatomy and measurements in a specific population is imperative to identify these variations and prevent avoidable intraoperative complications. Aim: To assess the normal intracranial measurements of the intercarotid distance, pituitary fossa width, optic chiasm height, optic chiasm width and the pituitary to optic chiasm distance in healthy subjects of the South Indian population aged between 10 to 80 years and establish normal reference ranges across the various age groups. Materials and Methods: This retrospective study was conducted in the Radiology Department at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from July 2021 to December 2021. The study included normal Magnetic Resonance Imaging (MRI) brains of 700 healthy subjects (378 males and 322 females) in the age range of 10 to 80 years. Subjects were divided into seven groups of 100 subjects for each decade. The variables that were measured included the intercarotid distance, pituitary fossa width, optic chiasm height, optic chiasm width and the pituitary to optic chiasm distance. RStudio version 1.2.1093 was used for statistical analysis and p-value <0.05 was considered statistically significant. Association between age and outcome variables was assessed by Pearson’s correlation coefficient and its 95% confidence interval. Results: The overall mean age was 45.4 years. The overall mean intercarotid distance was 16.2±3.7 mm, optic chiasm width was 13.1±1.6 mm, optic chiasm height was 2.18±2.7 mm, pituitary width was 12.1±2.3 mm, pituitary to optic chiasm distance was 5.7±1.84 mm. The overall pituitary fossa width and pituitary to optic chiasm distance was found to be higher in males (p-value <0.001; p-value=0.03 respectively) than females while there was no significant difference between genders in the rest of the parameters. A low and positive correlation was found between age and the pituitary width, age (r-value=0.175, p-value <0.001) and the pituitary to optic chiasm distance (r-value=0.342, p-value <0.001) and pituitary width and optic chiasm width (r-value=0.236, p-value <0.001). A strong and positive correlation was found between the pituitary width and the intercarotid distance (r-value=0.736, p-value <0.001). Conclusion: Establishment of normal reference values across various age groups of the South Indian population may prove useful for future reference and improving diagnostic accuracy.
Objectives: The objectives of the study were to compare the imaging findings and patient’s perception of barium defecating proctography and dynamic magnetic resonance (MR) proctography in patients with pelvic floor disorders. Material and Methods: This is a prospective study conducted on patients with pelvic floor disorders who consented to undergo both barium proctography and dynamic MR proctography. Imaging findings of both the procedures were compared. Inter-observer agreement (IOA) for key imaging features was assessed. Patient’s perception of these procedures was assessed using a short questionnaire and a visual analog scale. Results: Forty patients (M: F =19:21) with a mean age of 43.65 years and range of 21–75 years were included for final analysis. Mean patient experience score was significantly better for MR imaging (MRI) (p < 0.001). However, patients perceived significantly higher difficulty in rectal evacuation during MRI studies (p = 0.003). While significantly higher number of rectoceles (p = 0.014) were diagnosed on MRI, a greater number of pelvic floor descent (p = 0.02) and intra-rectal intussusception (p = 0.011) were diagnosed on barium proctography. The IOA for barium proctography was substantial for identifying rectoceles, rectal prolapse and for determining M line, p < 0.001. There was excellent IOA for MRI interpretation of cystoceles, peritoneoceles, and uterine prolapse and substantial to excellent IOA for determining anal canal length and anorectal angle, p < 0.001. The mean study time for the barium and MRI study was 12 minutes and 15 minutes, respectively. Conclusion: Barium proctography was more sensitive than MRI for detecting pelvic floor descent and intrarectal intussusception. Although patients perceived better rectal emptying with barium proctography, the overall patient experience was better for dynamic MRI proctography.
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