Autoři prezentují kazuistiku 3leté holčičky, u které byla pomocí zobrazovacích metod (USG a CT) prokázána přítomnost střevního parazita (škrkavka dětská, Ascaris lumbricoides) v tenkém střevě komplikovaná vícečetnou intermitentní intususcepcí.
The authors present a case report of a 3-year-old girl, with proving presence of intestinal parasites (roundworm, Ascaris lumbricoides) in the small intestine complicated brains of intermittent intussusception. Ultrasound and CT were major diagnostic tools in this case.
- MeSH
- antinematodní látky terapeutické užití MeSH
- Ascaris lumbricoides izolace a purifikace patogenita růst a vývoj MeSH
- askaridóza * diagnóza komplikace MeSH
- dítě MeSH
- intususcepce * parazitologie radiografie ultrasonografie MeSH
- lidé MeSH
- předškolní dítě MeSH
- tenké střevo parazitologie radiografie ultrasonografie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: In recent years, there has been renewed interest in small bowel imaging using a variety of radiologic or endoscopic techniques. This article gives an overview and comparison of old and new techniques used in small bowel imaging. New imaging methods as computed tomography (CT), CT enteroclysis (CTEc), CT enterography (CTEg), ultrasound (US), contrast-enhanced ultrasound (CEUS), US enteroclysis, US enterography, magnetic resonance imaging (MRI), MR enteroclysis (MREc) and MR enterography (MREg) are compared with the older techniques such as small- bowel follow- through (SBFT), conventional enteroclysis (CE) and endoscopic techniques including push enteroscopy, ezofagogastroduodenoscopy (EGD), sonde enteroscopy, ileocolonoscopy, double-balloon enteroscopy, intraoperative enteroscopy and wireless capsule enteroscopy (WCE). METHODS: Systematic scan of Pubmed, Medline, Ovid, Elsevier search engines was used.. Additional information was found through the bibliographical review of relevant articles. RESULTS: SBFT has only secondary role in small bowel imaging. US is still the method of choice in imaging for pediatric populations. US and CEUS are also accepted as a method of choice especially in inflammatory cases. CE has been replaced by new cross - sectional imaging techniques (CTEc/CTEg or MREc/MREg). CTEc combines the advantages of CT and CE. MREc combines the advantages of MRI and CE. Some authors prefer CTEg or MREg with peroral bowel preparation and they strictly avoid nasojejunal intubation under fluoroscopic control. MREc has better soft tissue contrast, showing it to be more sensitive in detecting mucosal lesions than CTEc in inflammatory diseases. CTEg/MREg are techniques preferred for patients in follow-up of the inflammatory diseases. The radiologic community is not unanimous however about their role in the imaging process. CTEc/MREc as well as CTEg/MREg are superior to endoscopic methods in the investigation of small-bowel tumors. WCE gives unparalleled imaging of the mucosal surface of the small bowel especially in the event of obscure gastrointestinal bleeding and inflammatory diseases. CONCLUSIONS: In a comparison of endoscopic and radiologic approaches, radiologic techniques are less invasive for patients, they take less time to investigate and allow imaging the entire small bowel. Some do not involve radiation exposure (US, MR). Endoscopic methods are more expensive, more invasive, need longer examination time and technical special skills but without radiation exposure. The greatest advantage of some endoscopic methods is the possibility of mucosal biopsy in one step with diagnostic examination (EGD, push enteroscopy, intraoperative enteroscopy, ileocolonoscopy).
- MeSH
- gastrointestinální endoskopie MeSH
- kontrastní látky aplikace a dávkování MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- počítačová rentgenová tomografie MeSH
- síran barnatý aplikace a dávkování diagnostické užití MeSH
- tenké střevo patologie radiografie ultrasonografie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Článek přináší přehled možností využití transabdominální ultrasonografie v zobrazení tenkého i tlustého střeva. Ultrazvuk je v poslední době velice přínosnou metodou nejen u pacientů s Crohnovou chorobou, ale i u ostatních střevních onemocnění. Zvláště pro svou neinvazivnost, dostupnost a výpovědní hodnotu je velice pohotovou metodou jak v první linii diagnostiky, tak i v rámci dlouhodobého sledování pacientů s chronickým onemocněním, jakým je např. Crohnova choroba či ulcerózní kolitida aj. Ultrazvuk umožňuje posoudit nejenom samotnou stěnu střevní a její jednotlivé vrstvy, ale i změny v okolí střeva, např. mesenterium, což zvyšuje senzitivitu metody v posouzení aktivity. V poslední době je snaha o širší využití kontrastních látek při sonografii, což by mělo zpřesňovat a objektivizovat aktivitu zánětlivých procesů.
This article summarises the possibilities of ultrasound imaging of the small and large bowel. Bowel ultrasound plays an important role above all in patients with Crohn's disease, but it could be used in other bowel pathological conditions as well. Dueto its non-invasiveness, availability and imaging efficiency, it is a suitable imaging modality both in first line diagnostics and in long-term follow-up in patients with chronic diseases such as IBD. Ultrasound is able to image not only the bowel wall and to separate bowel wall layers, but also the changes in the surroundings tissue or organs such as mesentery, which is able to increase the sensitivity of the method for disease activity assessment. Recently, there has been a tendency to use ultrasound contrast agents, which should allow a more precise assessment of activity of inflammatory processes.
- Klíčová slova
- zobrazovací metody, sledování,
- MeSH
- apendicitida ultrasonografie MeSH
- celiakie ultrasonografie MeSH
- idiopatické střevní záněty ultrasonografie MeSH
- kontrastní látky diagnostické užití MeSH
- lidé MeSH
- tenké střevo patologie ultrasonografie MeSH
- tlusté střevo patologie ultrasonografie MeSH
- ultrasonografie metody MeSH
- Check Tag
- lidé MeSH
Primary, secondary, benign or malignant tumorous diseases of the small intestine are rare. They are very often diagnosed by accident or as a cause of acute abdomen. Less serious symptoms can be overseen mainly in older patients. This work represents a prospective evaluation of a diagnostic and therapeutic algorithm in the management of the small-intestine tumor below the ligamentum Treitzi in patients over 65 years of age. RESULTS: A population of 96 patients who underwent surgery for a small-intestinal tumor in our hospital from 1996 to 2006 is presented. Thirty-four of these patients were older than 65 years. Ultrasound of the small intestine was sufficient to make the diagnosis in 21 of them. Elective surgery (laparoscopy was highly preferred) could be offered to 31 of these older patients. Perioperative mortality was zero. CONCLUSION: The small-bowel ultrasound can be recommended as the first choice method. All complaints regarding the gastrointestinal tract should be verified. Older patients can be safely offered an elective laparoscopic surgery with acceptable morbidity and mortality.
- MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- střevní nádory chirurgie ultrasonografie MeSH
- tenké střevo chirurgie ultrasonografie MeSH
- ultrasonografie metody MeSH
- věkové faktory MeSH
- věkové rozložení MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Amyloidosis is a rare disease characterized by forming pathological protein deposits - amyloid - in many organs and tissues. This decreases their functionality. The aim of this small study was to determine, whether the radiological picture of the small intestine involvement in amyloidosis is in some sense specific as sometimes described in literature giving rise to high suspicion for the disease in symptomatic patients. MATERIAL AND METHODS: The prospective study comprising seven patients hospitalized in surgical department is presented together with a survey on the disease, its appearance in radiological imaging. All patients underwent abdominal ultrasound (ATL 5000 HDI, 7-12MHz linear probe, no contrast enhancement, supine position), abdominal CT (Somatom Plus, Siemens, single detector, conventional abdominal CT protocol) and enteroclysis (Micropaque suspension 300ml, application rate of 75ml/min, dilution with HP-7000 being 1:1 and HP-7000 solution 2000ml, application rate of 120ml/min.). RESULTS: The amyloid deposits in the small intestine could be visualized in five of seven patients with the disease. Enteroclysis revealed a diffuse slowed down intestinal motility with an obstruction-like picture in all of our seven patients. The intestinal secretion was normal, plicae were getting polyp-like shape in five of them forming so called "thumb printing" picture. CT showed thickening of the intestinal wall due to deposits with poor blood supply and contrast retention in five of seven patients. Ultrasound visualized thickened, hypoechoic nodular plicae and slowed down motility in these five patients. The most striking finding was the pathological deposits in the intestinal wall were highly hypo-vascular. However, this picture is very similar to that of ischemic enteritis. All seven patients had proven amyloid deposits from bioptic specimens. CONCLUSION: The diagnosis of amyloidosis must be supported by bioptic examination as it has no pathognomic radiological picture. Nevertheless, it allows usually to rise a high suspicion for this and sometimes even guess the type of the pathological protein involved. This can start a search for the primary reason of possible amyloidosis and thus perhaps spear the patients quality of life.
- MeSH
- amyloidóza diagnóza komplikace MeSH
- dyspepsie etiologie MeSH
- gastrointestinální intubace metody MeSH
- kontrastní látky aplikace a dávkování MeSH
- lidé MeSH
- nemoci střev diagnóza MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- senzitivita a specificita MeSH
- síran barnatý diagnostické užití MeSH
- tenké střevo radiografie ultrasonografie MeSH
- vylepšení obrazu metody MeSH
- vzácné nemoci MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- hodnotící studie MeSH
OBJECTIVE: Celiac disease (CD) is a common, lifelong disease with small bowel malabsorption based on genetically conditioned gluten intolerance. The clinical manifestation could be very heterogeneous. The proof of celiac disease is now based mainly on clinical and laboratory (antibodies and enterobiopsy) signs, which are in some cases problematic and inconvenient. MATERIALS AND METHODS: In our study we have examined 250 patients with suspection or with proven celiac disease and we evaluated specific ultrasound small bowel changes in this group. In the next step, we chose 59 patients with laboratory proved celiac disease and we statistically compared ultrasound, other laboratory and clinical findings in different forms and stages of the disease. RESULTS: Specific small bowel pathologies in patients with celiac disease (like changes of intestinal villi in different parts of small bowel, abnormal peristalsis and mesenterial lymphadenopathy) can be well visualized by ultrasound and in combination with clinical and laboratory signs ultrasound examination could have an important role in screening, determination of diagnosis and monitoring of patients with different forms of celiac disease.
- MeSH
- celiakie ultrasonografie MeSH
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- senioři MeSH
- tenké střevo ultrasonografie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- senioři MeSH
- ženské pohlaví MeSH
Crohn's disease is more likely a systemic disease governed by a shift in the immune response, thus affecting the whole MALT system. Its treatment should be as conservative as possible and surgery is usually taking place after complications like indolent fistulations, stenoses, bleeding, or bowel perforation started. Standard radiological methods to check the extent of the disease are loaded either with certain radiation exposure (enteroclysis, CT) or lack standardization (ultrasound). The aim of this small study was to evaluate the worth of ultrasound-enteroclysis in detecting the extent and complications of the Crohn's disease in surgically treated patients. MATERIAL AND METHODS: Since 1997, when we started with the ultrasound-enteroclysis, 246 surgical performances were involved into our study. Out of them, 181 had conventional abdominal intestinal ultrasound as well as conventional enteroclysis within 1 week. Remaining 65 cases were diagnosed by the ultrasound-enteroclysis. Intestinal ultrasound was performed on the Ultramark 3000 HDI device with autofocussable convex 5 MHz and linear 7.5 MHz probes or nowadays ATL 5000 HDI, 7-12 MHz linear probe. No contrast enhancement was used. Enteroclysis was done with the Micropaque suspension diluted 1:1 with HP-7000 300 ml with its application rate up to 75 ml/min followed by HP-7000 solution 2000 ml, application rate of 120 ml/min. The patients with ultrasound-enteroclysis were applied HP 7000 solution only (2000 ml, rate 100ml/s) via an enteroclysis catheter. All investigations were video-recorded. RESULTS: Consent with the per-operative finding was reached in 162 from 181 enteroclyses and in 169 of 181 ultrasounds. Ultrasound-enteroclysis was precise in 61 cases from 65. Among these, 60 patients had the recurrence during the treatment proved by clinical and laboratory results. This re-activation was clearly revealed in 38 from 43 cases by enteroclysis, 41 from 43 by US and in 16 from 17 by ultrasound-enteroclysis. From 30 patients that developed acute complication non-responding to the conservative therapy (abscesses, fistulas and intestinal obstructions) there were 18 from 20 accurately diagnosed by enteroclysis, only 12 from 20 by US and 9 from 10 by US-enteroclysis. The differences were either statistically non-significant or there were too small numbers to give sensible statistical results, but low sensitivity of ultrasound in complications (p=0.05). CONCLUSION: US-enteroclysis seems to became the standard examination of patients with Crohn's disease mainly in those with unclear conventional ultrasound. The most important fact is that this examination significantly decreases the radiation load when maintaining high sensitivity. This is very important namely in patients with Crohn's disease that require life-long observation and repeated examinations. This examination is much more easy to standardize than the conventional US.
- MeSH
- audiovizuální záznam MeSH
- Crohnova nemoc chirurgie patologie ultrasonografie MeSH
- endosonografie metody přístrojové vybavení škodlivé účinky MeSH
- kontrastní látky MeSH
- lidé MeSH
- prediktivní hodnota testů MeSH
- senzitivita a specificita MeSH
- síran barnatý diagnostické užití MeSH
- stupeň závažnosti nemoci MeSH
- tenké střevo chirurgie patologie ultrasonografie MeSH
- ultrasonografie dopplerovská metody MeSH
- zaváděcí katétry škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- hodnotící studie MeSH
- Geografické názvy
- Česká republika MeSH
- Klíčová slova
- malasimilační syndrom,
- MeSH
- amyloidóza MeSH
- celiakie * MeSH
- Crohnova nemoc MeSH
- enteritida chemicky indukované MeSH
- enterocyty metabolismus MeSH
- giardiáza MeSH
- imunoproliferační nemoc tenkého střeva MeSH
- lidé MeSH
- lymfom z T-buněk asociovaný s enteropatií MeSH
- střevní sliznice * patofyziologie MeSH
- tenké střevo * ultrasonografie MeSH
- tropická sprue MeSH
- tuberkulóza gastrointestinální MeSH
- Whippleova nemoc MeSH
- Check Tag
- lidé MeSH
- MeSH
- Crohnova nemoc diagnóza ultrasonografie MeSH
- diagnostické zobrazování metody MeSH
- dítě MeSH
- kontrastní látky aplikace a dávkování diagnostické užití MeSH
- lidé MeSH
- mladiství MeSH
- sloučeniny barya aplikace a dávkování diagnostické užití MeSH
- tenké střevo patologie ultrasonografie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
