Akut Karın Ağrısının Nadir Sebepleri ve BT Bulguları

Öz

Akut karın ağrısı radyologların günlük pratiklerinde karşılaştıkları ve çözmeleri istenen en sık problemdir. Laparotomiden önce sıklıkla görüntüleme yapılması gerekir. Bilgisayarlı tomografi BT zor ve aciliyeti olan olguların etiyolojisinin aydınlatılmasında ve ağrıya yönelik tedaviye karar vermede ilk başvurulan radyolojik yöntemdir. Çalışmada akut karın ağrısına sebep olan, klinik tanı koymada güçlük yaşanan ve BT görüntüleme ile sebebin ortaya çıkarıldığı sık karşılaşılmayan sebepler gözden geçirilmiştir

Anahtar Kelimeler

• Karın, Akut, Ayırıcı tanı, Çok kesitli bilgisayarlı tomografi

CT Findings of Unusual Causes of Acute Abdomen

Abstract

Acute abdomen is one of the most common problems that radiologists face in daily practice. Imaging is used as the last stop before laparotomy, and computed tomography CT is now almost always the first step both in helping solve various difficult, urgent cases and in deciding on the management for the pain. In this study, we review a number of rare cases of abdominal pain in which the preliminary diagnosis could not be made clinically, but where CT images revealed the causes

Keywords

• Acute abdomen, Differential diagnosis, Multidetector computed tomography

References

1. 1. Aguirre DA, Casola G, Sirlin C. Abdominal wall hernias: MDCT findings. Am J Roentgenol 2004;183:681–90.
2. 2. Aguirre DA, Santosa AC, Casola G, Sirlin CB. Abdominal wall hernias: Imaging features, complications, and diagnostic pitfalls at multi–detector row CT. Radiographics 2005;25:1501–20.
3. 3. Ianora AA, Midiri M, Vinci R, Rotondo A, Angelelli G. Abdominal wall hernias: Imaging with spiral CT. Eur Radiol 2000;10:914–9.
4. 4. Constantine S. Computed tomography appearances of Amyand hernia. J Comput Assist Tomogr 2009;33:359– 62.
5. 5. Lassandro F, Iasiello F, Pizza NL, Valente T, Stefano ML, Grassi R, Muto R. Abdominal hernias: radiological features. World J Gastrointest Endosc 2011;3:110–7.
6. 6. Mathieu D, Luciani A; GERMAD Group. Internal abdominal herniations. Am J Roentgenol 2004;183:397– 404.
7. 7. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: Radiographic and clinical findings. Am J Roentgenol 2006;186:703–17.
8. 8. Emanuwa OF, Ayantunde AA, Davies TW. Midgut malrotation first presenting as acute bowel obstruction in adulthood: A case report and literature review. World J Emerg Surg 2011;6:22.

9. 9. Sodhi KS, Bhatia A, Saxena AK, Rao KL, Menon P, Khandelwal N. Anticlockwise swirl of mesenteric vessels: A normal CT appearance, retrospective analysis of 200 pediatric patients. Eur J Radiol 2014;83:710–4.
10. 10. Peterson CM, Anderson JS, Hara AK, Carenza JW, Menias CO. Volvulus of the gastrointestinal tract: Appearances at multimodality imaging. Radiographics 2009;29:1281–93.
11. 11. Carucci LR, Turner MA. Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity. Eur J Radiol 2005;53:353–65.
12. 12. Saleni MH, Coffman SE, Postlethwait RW. Retrograde intussusception at the gastrojejunal stoma. Ann Surg 1959;150:864–71.
13. 13. Zenooz NA, Holz SP, Robbin MR. Jejunogastric intussusception: A case report with the review of literature. Emerg Radiol 2007;13:265–7.
14. 14. Rossi P, Gourtsoyiannis N, Bezzi M, Raptopoulos V, Massa R, Capanna G, Pedicini V, Coe M. Meckel’s diverticulum: imaging diagnosis. Am J Roentgenol 1996;166:567–73.
15. 15. Elsayes KM, Menias CO, Harvin HJ, Francis IR. Imaging manifestations of Meckel’s diverticulum. Am J Roentgenol 2007;189:81–8.
16. 16. Satya R, O’Malley JP. Case 86: Meckel diverticulum with massive bleeding. Radiology 2005;236: 836–40.
17. 17. Levy AD, Hobbs CM. From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic correlation. Radiographics 2004;24:565–87.
18. 18. Tannoury JN, Abboud BN. Idiopathic sclerosing encapsulating peritonitis: Abdominal cocoon. World J Gastroenterol 2012;18:1999–2004.
19. 19. Serter A, Kocakoc E, Cipe G. Supposed to be rare cause of intestinal obstruction; Abdominal cocoon: Report of two cases. Clin Imaging 2013;37:586–9.
20. 20. Choi JH, Kim JH, Kim JJ. Large bowel obstruction caused by sclerosing peritonitis: Contrast-enhanced CT findings. Br J Radiol 2004;77:344–6.
21. 21. Kirtland HB Jr. Dermoid cyst of the omentum, with report of a case. Calif Med 1951;75:44–5.
22. 22. Yoshida A, Murabayashi N, Shiozaki T. Case of mature cystic teratoma of the greater omentum misdiagnosed as ovarian cyst. J Obstet Gynaecol Res 2005;31:399–403.
23. 23. Ratan SK, Ratan J, Kalra R. Large benign cystic teratoma of the mesosigmoid causing intestinal obstruction: Report of a case. Surg Today 2002;32:922–4.
24. 24. Verswijvel G, Janssens F, Vanboven H, Palmers Y. Spontaneous rupture of mesenteric dermoid cyst: A rare cause of abdominal pain. Eur Radiol 2004;14:1517–8.
25. 25. Dufay C, Abdelli A, Le Pennec V. Mesenteric tumors: Diagnosis and treatment. J Visc Surg 2012;149: e239–51.
26. 26. Chourmouzi D, Sinakos E, Papalavrentios L. Gastrointestinal stromal tumors: A pictorial review. J Gastrointestin Liver Dis 2009;18:379–83.
27. 27. Kochhar R, Manoharan P, Leahy M. Imaging in gastrointestinal stromal tumours: Current status and future directions. Clin Radiol 2010;65:584–92.
28. 28. Choi YR, Kim SH, Kim SA, Shin CI, Kim HJ, Kim SH, Han JK, Choi BI. Differentiation of large (≥ 5cm) gastrointestinal stromal tumors from benign subepitelial tumors in the stomach: Radiologists’ performance using CT. Eur J Radiol 2014;83:250–60.
29. 29. O’Sullivan PJ, Harris AC, Ho SG, Munk PL. The imaging features of gastrointestinal stromal tumours. Eur J Radiol 2006;60:431–8.
30. 30. Cegarra-Navarro MF, Corral de la Calle MA, GirelaBaena E. Ruptured gastrointestinal stromal tumors: radiologic findings in six cases. Abdom Imaging 2005;30:535–42.
31. 31. Antopolsky M, Hiller N, Salameh S. Splenic infarction: 10 years of experience. Am J Emerg Med 2009; 27: 262–5.
32. 32. Abeysekera WYM, de Silva WD, Pinnaduwa SS, Banagala AS. Acute massive splenic infarction with splenic vein thrombosis following altitude exposure of a Sri Lankan male with undetected sickle cell trait. High Alt Med Biol 2012;13:288–90.
33. 33. Wunnava RV, Hunt TM. An unusual cause of acute abdominal pain- a case presentation. BMC Blood Disord 2006;6:1.
34. 34. Beeson MS. Splenic infarct presenting as acute abdominal pain in an older patient. J Emerg Med 1996; 14: 319–22.
35. 35. Urban BA, Fishma EK. Helical CT of the spleen. Am J Roentgenol 1998;170:997–1003.
36. 36. Bent C, Iyngkaran T, Power N, Matson M, Hajdinjak T, Buchholz N, Fotheringham T. Urological injuries following trauma. Clin Radiol 2008;63:1361–71.
37. 37. Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR. Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics 2003;23:1133–47.
38. 38. Goldman SM, Sandler CM. Urogenital trauma: Imaging upper GU trauma. Eur J Radiol 2004;50: 84–95.
39. 39. O’Connor AR, Coakley FV, Meng MV, Eberhardt SC. Imaging of retained surgical sponges in the abdomen and pelvis. Am J Roentgenol 2003;180:481–9.
40. 40. Gayer G, Petrovitch I, Jeffrey RB. Foreign objects encountered in the abdominal cavity at CT. Radiographics 2011;31:409–28.
41. 41. da Costa Martins B, Medrado BF, de Lima MS, Retes FA, Kawaguti FS, Pennacchi CM, Maluf-Filho F. Esophageal metallic stent fixation with dental floss: A simple method to prevent migration. Endoscopy 2013;45(S 02):E342.
42. 42. Chandler RC, Srinivas G, Chintapalli KN, Schwesinger WH, Prasad SR. Imaging in bariatric surgery: A guide to postsurgical anatomy and common complications. Am J Roentgenol 2008;190:122-35.
43. 43. Berkun Y, Eisenstein EM. Diagnostic criteria of familial Mediterranean fever. Autoimmun Rev 2014;13:388-90.
44. 44. Zissin R, Rathaus V, Gayer G, Shapiro-Feinberg M, Hertz M. CT findings in patients with familial Mediterranean fever during an acute abdominal attack. Br J Radiol 2003;76:22-5.
45. 45. Aharoni D, Hiller N, Hadas-Halpern I. Familial Mediterranean fever: Abdominal imaging findings in 139 patients and review of the literature. Abdom Imaging 2000; 25:297-300.