An 86-year-old man was admitted to hospital because of transitory cramp-like abdominal pain of 6 days' duration. Immediately preceding admission he had suffered a short episode of vomiting and diarrhoea. There was no history of previous abdominal operation. On examination there were signs of incomplete mechanical ileus. Ultrasonography revealed an abnormal cockade with triple ring phenomenon at the ileocaecal junction and the "duck-beak phenomenon" as signs of enterocolic intussusception. Immediate laparotomy demonstrated a submucous lipoma of the terminal ileus as its cause.--If there is clinical suspicion of intussusception, even in the presence of atypical abdominal symptoms, ultrasonography is the procedure of choice to provide rapid diagnosis. In adults treatment is always surgical.
The following are the specifications for intraoperative sonography equipment: Small, easy-to-manipulate 7-10 mHz probes which can be gas-sterilised. The sound head contact surface should be 2 X 3 X 1 to 2 cm. Three probes of different shape. Transmission cable 2-3 m in length. Gas-sterilisable ultrasound unit, cable and plug. Large screen monitor. Control panel which can be encased with a plastic foil according to sterility requirements. 8 step gray scale. Integrated image storage. Documentation possibility using videotape and/or photographic unit. For intraoperative sonography the body parts to be examined are sonographed at a distance of 1-2 cm using a precursor water gap. Interpretation of sonographic images can be performed only in connection with the palpation findings of the surgeon.
The reliability of sonography and peritoneal lavage in assessing the need for immediate surgical intervention in blunt abdominal trauma was examined in a controlled prospective and retrospective study. Whereas no false results occurred using peritoneal lavage, false negative findings in sonography were 9.8% and false positive findings 3.9%. A significant difference was also found on retrospective evaluation of all cases with diagnostic peritoneal lavage (2.2% false results) and ultrasound investigations (14.9% false results). This demonstrates that sonography cannot fully replace peritoneal lavage as a diagnostic method in blunt abdominal trauma.
Report on intraoperative sonography in 257 patients (89 with pancreatic and 67 with liver disease, 24 with vascular surgery and 24 with bile duct disease). Intraoperative sonography was helpful for the detection of tumors not evident by inspection and palpation. In vascular surgery it proved to be an excellent means for quality control. The main problems encountered concerned the evaluation of the bile ducts and of haemodynamically insignificant vessel wall lesions.
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