Four cases of perforation of the colon above the peritoneal reflection during a barium-enema examination were reviewed with regard to the type of examination, site of perforation, status of the colon, clinical manifestations, mode of detection, and consequences. Perforation above the peritoneal reflection does not seem to be directly related to technical factors. The cecum and ascending colon, with their larger lumina, are the most likely sites. Because such patients are usually asymptomatic at the time, careful examination of post-fluoroscopic radiographs for signs of perforation is strongly recommended.
The use of vasopressin infusion or arterial embolization in the treatment of 87 patients with gastrointestinal hemorrhage is reviewed. A bleeding point was identified angiographically in 46 patients (53%), with a higher success rate in those with upper gastrointestinal hemorrhage (63%) than in those with lower (39%) gastrointestinal hemorrhage. Vasopressin infusion in 33 patients completely stopped hemorrhage in 14 and slowed hemorrhage pending surgery in another 5. Gelfoam embolization was successful as definitive therapy in 12 of 15 patients. Mortality as a result of hemorrhage or its sequelae was 40% in patients with upper gastrointestinal hemorrhage and 21% in those with lower gastrointestinal hemorrhage.
Duodenal tuberculosis is a very rare disease and is usually associated with active pulmonary tuberculosis. These patients may present with symptoms and initial radiographic findings of pyloric canal obstruction. Hypotonic duodenography may reveal a submucosal mass with no other specific changes. The lesion is unpredictable. It may respond to medical therapy but it may also progress and require surgical intervention.
Described here is a patient with 2 large pedunculated colonic tumors detected by barium enema radiography. By computed tomography (CT) 1 was found to be a submucosal lipoma characterized by oval shape, smooth demarcation, and homogeneous density with a CT number of -68 HU, whereas the other was an adenomatous polyp with slightly fuzzy outline and a much higher CT number. This case indicates that CT can be a definitive diagnostic modality for distinguishing between a colonic lipoma and other solid or cystic tumor of the colon.
A case of hepatic myelolipoma is described, including the angiographic and computed tomographic appearance. Only three such cases have been reported previously.
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