CT Findings in the Abdomen and Pelvis After Gastric Carcinoma Resection

Size: px
Start display at page:

Download "CT Findings in the Abdomen and Pelvis After Gastric Carcinoma Resection"

Transcription

1 CT Findings in the Abdomen and Pelvis After Gastric Carcinoma Resection Kyeong Ah Kim 1, Cheol Min Park 1, Sang Woo Park 1, Sang Hoon Cha 1, Hae Young Seol 1, In Ho Cha 1, Ki Yeol Lee 2 G astric carcinoma is a common malignancy that results in significant morbidity and mortality. Patients who have undergone gastric carcinoma resection present challenging problems to their physicians. The radiologist is frequently asked to define the postsurgical anatomy to assess the efficacy of the procedures and to detect early and late postoperative complications. CT is valuable for documenting normal postoperative anatomy, identifying recurrences, evaluating anatomic relationships, and confirming the absence of new lesions in the abdomen and pelvis after gastric carcinoma resection. Compared with the large number of articles describing preoperative assessment of gastric carcinoma, few reports have been published on the CT findings in the abdomen and pelvis after gastric carcinoma resection. We illustrate the CT findings of normal postoperative appearance, postoperative complications, and tumor recurrence in the abdomen and pelvis. CT Technique In all patients, helical CT was performed with a single 20- to 25-sec breath-hold using a slice collimation of 10 mm and a table pitch of 1:1. The key to CT of the stomach is gastric distention, because wall thickening can be simulated by underdistention. Each patient drank 200 ml of water just before undergoing CT. Scanning was started 45 sec after the IV injection of ml of nonionic contrast agent at a rate of 3 ml/sec. Normal Postoperative Appearance A variety of procedures are used to treat gastric carcinoma. Depending on the location Fig year-old woman with nonobstructive biliary dilatation after esophagojejunostomy. Contrast-enhanced CT scan shows dilatation of peripheral (thin arrows) and central (thick arrow) bile ducts. No obstructing lesion was found in bile duct. Pictorial Essay of the tumor, a subtotal or total gastrectomy or an esophagogastrectomy may be performed. Mild dilatation of the bile ducts without mechanical biliary obstruction can be seen on follow-up CT after gastrectomy and vagotomy (Fig. 1). This nonobstructive biliary dilatation is possibly caused by altered biliary tract hormonal response or sphincter of Oddi dysfunction. If a patient has no clinical symptoms, no further evaluation is required. Surgical plications (Fig. 2) may mimic masses; this is a potential source of erroneous Fig year-old man with surgical plications mimicking recurrent tumor. Contrast-enhanced CT scan shows polypoid elevation (arrow) at anastomosis. Received August 8, 2001; accepted after revision March 26, Department of Radiology, Medical Science Research Center, Korea University Guro Hospital, 80, Guro-Dong, Guro-Ku, Seoul, , Korea. Address correspondence to C. M. Park. 2 Department of Radiology, Inje University Paik Hospital, 85, 2Ka, Jur-Dong, Chung-Ku, Seoul, , Korea. AJR 2002;179: X/02/ American Roentgen Ray Society AJR:179, October

2 Kim et al. Fig year-old man with abscess of left subphrenic space after subtotal gastrectomy. Abscess (A) is limited by falciform ligament, which prevents spread to right subphrenic space. Fig year-old woman with bezoar in stomach remnant. Contrast-enhanced CT scan shows floating inhomogeneous mass with entrapped air (arrow). Fig year-old man with incisional hernia. Contrast-enhanced CT scan shows knucklelike portion of small bowel (arrows) protruding beneath healed midline incision. Fig year-old woman with tumor recurrence near celiac axis. Contrast-enhanced CT scan shows enlarged lymph nodes (arrows) surrounding celiac axis Fig year-old woman with afferent loop syndrome after Billroth II operation. Contrast-enhanced CT scan shows massively dilated duodenum (D) posterior to superior mesenteric artery (arrow) and anterior to spine. Fig year-old man with hiatal hernia after subtotal gastrectomy. Contrast-enhanced CT scan shows herniated gastric remnant (H) through esophageal hiatus above diaphragm. Fig year-old man with tumor recurrence at anastomosis site. Contrast-enhanced CT scan shows mucosal thickening and contrast enhancement at gastrojejunostomy site (arrows). AJR:179, October 2002

3 CT After Gastric Carcinoma Resection Fig year-old man with tumor recurrence in pancreas. Contrast-enhanced CT scan shows diffuse low-attenuation mass (arrows) that is infiltrating entire pancreas. Fig year-old woman with invasion of transverse colon via gastrocolic ligament. Contrast-enhanced CT scan shows irregular wall thickening (arrows) in transverse colon. Fig year-old woman with tumor recurrence along abdominal incision. Contrast-enhanced CT scan shows inhomogeneously enhancing mass (arrow) in anterior wall of abdomen. Fig year-old man with metastatic lymphadenopathy. Contrast-enhanced CT scan shows conglomerate lymphadenopathy (N) in left paraaortic area. Fig year-old man with peritoneal seeding. A, Contrast-enhanced CT scan reveals omental metastasis. Smudged omentum with small nodules and infiltrated fat (arrows) can be seen. B, Contrast-enhanced CT scan shows perirectal drop metastasis. Note well-enhancing tumor (arrows) in pouch of Douglas. A AJR:179, October 2002 B 1039

4 Kim et al. Fig year-old woman with metastatic linitis plastica of rectum and Krukenberg s tumor of ovary. Patient underwent total gastrectomy for signet ring cell type gastric carcinoma. Contrast-enhanced CT scan shows concentric thickening (arrow) of rectal wall with target sign and infiltration into perirectal fat plane. Note right ovarian mass (K) and ascites (a). interpretation of local tumor recurrence in the gastrointestinal tract. Postoperative Complications Anastomotic Leak and Abscess Fig year-old man with ureteral metastasis. Contrastenhanced CT scan shows thickened, enhanced right proximal ureteral wall with luminal narrowing and periureteral infiltrations (arrows). Breakdown of a suture line and leakage occur at the anastomosis between the stomach and the small bowel. CT may be needed to fully define the abscess cavity (Fig. 3) and to direct percutaneous drainage. Afferent Loop Syndrome Most cases of afferent loop syndrome are caused by mechanical obstruction of the afferent loop from adhesions, kinking at the anastomosis, internal hernia, stomal stenosis, malignancy, or inflammation surrounding the anastomosis. CT plays a major role in the diagnosis of this entity, because the clinical signs and symptoms are generally nonspecific. The CT finding is a fluid-filled, dilated, transversely oriented portion of small bowel anterior to the spine in the middle of the abdomen [1] (Fig. 4). Bezoar Bezoar formation (Fig. 5) is a complication of gastrectomy, particularly when gastectomy is combined with vagotomy. Diminished peristalsis and absence of gastric acid allow poorly chewed fibrous material to be retained and form a matted mass. This complication should be suspected whenever radiologic findings show a large discrete mass of food in the partially resected stomach of a fasting patient [2]. Incisional Hernia These hernias tend to occur during the first 4 months after surgery, a critical period for the healing of transected muscular and fascial layers of the abdominal wall. CT can Fig year-old man with portal vein tumor thrombosis. Contrast-enhanced CT scan shows dilated, nonopacified main and right lobar branches of portal vein (open arrows). Biopsy-proven multiple hepatic metastases (solid arrows) are also present. show small defects in peritoneal and fascial layers of abdominal wall through which the omentum or a knuckle of intestine protrudes into the subcutaneous fat [3] (Fig. 6). Esophageal Hiatal Hernia Herniation of abdominal content through the esophageal hiatus above the diaphragm (Fig. 7) is another complication of gastric carcinoma resection. Tumor Recurrence Local Recurrence Local recurrence of gastric carcinoma after surgery is defined as histologic evidence of a tumor in the surrounding tissue of the resected stomach. The most common sites of recurrence are in the area of the celiac axis (Fig. 8) or hepatic pedicle, followed by the 1040 AJR:179, October 2002

5 CT After Gastric Carcinoma Resection anastomotic site (Fig. 9) or gastric stump, pancreas (Fig. 10), and abdominal wall incision site [4] (Fig. 11). Direct Extension Tumor tissue may spread to adjacent organs via ligaments or peritoneal reflections. The liver may be invaded via the gastrohepatic ligament, the transverse colon via the gastrocolic ligament (Fig. 12), and the pancreas via the lesser sac. Lymphatic Spread Because of the abundant lymphatics in the stomach, lymph node metastases are common in patients with gastric carcinoma. These patients may initially have involvement of local nodes and, subsequently, regional or distant nodes (Fig. 13). Intraperitoneal Seeding Intraperitoneal seeding may be manifested on CT scans as nodules, loculated fluid collections, or irregular, beaded thickening and stranding of the mesentery or omentum (Fig. 14A). The pouch of Douglas is the most dependent portion of the peritoneal cavity and is a common site for drop metastases (Fig. 14B). Hematogenous Metastases Because the venous return from the stomach is drained by the portal vein, the liver is the most common site of bloodborne metastases. Less common sites include the lungs, adrenal glands, kidneys, and bones. Unusual Manifestations of Metastases Ureteral Metastases Most cases of ureteral metastases are associated with advanced gastric carcinoma with multiple perigastric and paraaortic lymphadenopathy and diffuse omental and mesenteric tumor infiltration. The CT findings are a thickened, enhanced ureteral wall with periureteral infiltration (Fig. 15), obstructive hydronephrosis, and hydroureter [5]. Bowel Metastases On helical CT, intestinal metastases from gastric carcinoma most commonly show long segmental wall thickening (Fig. 16) with a thick inner enhancing layer [6]. Portal Vein Tumor Thrombosis Gastric carcinoma should be considered a possibility in the diagnosis of portal vein tumor thrombosis (Fig. 17), even if the serum α-fetoprotein level is elevated and a liver tumor is identified [7]. The portal tumor thrombus is presumed to have arisen from vascular invasion in the primary foci of gastric carcinoma, and then to have permeated the portal vein without invasion of the liver parenchyma. References 1. Wise SW. Case 24: afferent loop syndrome. Radiology 2000;216: Smith CH, Gore RM. Postoperative stomach and duodenum. In: Gore RM, Levine MS, eds. Textbook of gastrointestinal radiology. Philadelphia: Saunders, 2000: Harrison LA, Keesling CA, Martin NL, Lee KR, Wetzel LH. Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging. RadioGraphics 1995;15: Ha HK, Kim HH, Kim HS, Lee MH, Kim KT, Shinn KS. Local recurrence after surgery for gastric carcinoma: CT findings. AJR 1993;161: Choi HY, Cho KS, Lee MG, et al. Stomach cancer with ureteral metastasis: CT findings and mode of metastasis. J Korean Radiol Soc 1992;28: Jang HJ, Lim HK, Kim HS, et al. Intestinal metastases from gastric adenocarcinoma: helical CT findings. J Comput Assist Tomogr 2001;25: Araki T, Suda K, Sekikawa T, Ishii Y, Hihara T, Kachi K. Portal venous tumor thrombosis associated with gastric adenocarcinoma. Radiology 1990;174: AJR:179, October

Follow up CT Findings of Various Types of Recurrence after Curative Gastric Surgery 1

Follow up CT Findings of Various Types of Recurrence after Curative Gastric Surgery 1 Follow up T Findings of Various Types of Recurrence after urative Gastric Surgery 1 Hye-Jeong Lee, M.D., Myeong-Jin Kim, M.D., Joon Seok Lim, M.D., Ki Whang Kim, M.D. lthough the detection of recurred

More information

Gastrectomy procedure and its complications: Findings at TC multi-detector 64 row.

Gastrectomy procedure and its complications: Findings at TC multi-detector 64 row. Gastrectomy procedure and its complications: Findings at TC multi-detector 64 row. Poster No.: C-2184 Congress: ECR 2012 Type: Educational Exhibit Authors: M. M. Mendigana Ramos, A. Burguete, A. Sáez de

More information

Imaging in gastric cancer

Imaging in gastric cancer Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.

More information

C. CT scan shows ascites and thin enhancing parietal peritoneum

C. CT scan shows ascites and thin enhancing parietal peritoneum 291 A B Fig. 1. A 55-year-old gastric cancer patient with peritoneal carcinomatosis. At surgery, there was large amount of ascites in peritoneal cavity and there were multiple small metastatic nodules

More information

Appendix 5. EFSUMB Newsletter. Gastroenterological Ultrasound

Appendix 5. EFSUMB Newsletter. Gastroenterological Ultrasound EFSUMB Newsletter 87 Examinations should encompass the full range of pathological conditions listed below A log book listing the types of examinations undertaken should be kept Training should usually

More information

Pre-operative assessment of patients for cytoreduction and HIPEC

Pre-operative assessment of patients for cytoreduction and HIPEC Pre-operative assessment of patients for cytoreduction and HIPEC Washington Hospital Center Washington, DC, USA Ovarian Cancer Surgery New Strategies Bergamo, Italy May 5, 2011 Background Cytoreductive

More information

Laparoscopy-assisted D2 radical distal subtotal gastrectomy

Laparoscopy-assisted D2 radical distal subtotal gastrectomy Masters of Gastrointestinal Surgery Laparoscopy-assisted D2 radical distal subtotal gastrectomy Xiaogeng Chen, Weihua Li, Jinsi Wang, Changshun Yang Department of Tumor Surgery, Fujian Provincial Hospital,

More information

Case Report pissn J Korean Soc Radiol 2012;67(4): INTRODUCTION CASE REPORT

Case Report pissn J Korean Soc Radiol 2012;67(4): INTRODUCTION CASE REPORT Case Report pissn 1738-2637 Focal Fat Deposition Developed in the Segment IV of the Liver Following Gastrectomy Mimicking a Hepatic Metastasis: Two Case Reports 1 위절제술후에간의제 4 분절에서발생한간전이를닮은국소지방침윤 : 두증례보고

More information

Abdominal Imaging. Afferent loop obstruction after gastric cancer surgery: helical CT findings

Abdominal Imaging. Afferent loop obstruction after gastric cancer surgery: helical CT findings Abdom Imaging 28:624 630 (2003) DOI: 10.1007/s00261-002-0070-y Abdominal Imaging Springer-Verlag New York Inc. 2003 Afferent loop obstruction after gastric cancer surgery: helical CT findings H.-C. Kim,

More information

Multiple Primary Quiz

Multiple Primary Quiz Multiple Primary Quiz Case 1 A 72 year old man was found to have a 12 mm solid lesion in the pancreatic tail by computed tomography carried out during a routine follow up study of this patient with adult

More information

CT EVALUATION OF GASTRIC LESIONS:

CT EVALUATION OF GASTRIC LESIONS: CT EVALUATION OF GASTRIC LESIONS: Pictural essay Hasni Bouraoui I, Kahloun A, Jemni H, Elouni F, Moulahi H, Daadoucha A, Ben Ali A, Sriha B, Tlili Graies K Departments of Radiology, Gastro enterology,

More information

The abdominal Esophagus, Stomach and the Duodenum. Prof. Oluwadiya KS

The abdominal Esophagus, Stomach and the Duodenum. Prof. Oluwadiya KS The abdominal Esophagus, Stomach and the Duodenum Prof. Oluwadiya KS www.oluwadiya.com Viscera of the abdomen Abdominal esophagus: Terminal part of the esophagus The stomach Intestines: Small and Large

More information

Imaging iconography of gallbladder cancer. Assessment by CT.

Imaging iconography of gallbladder cancer. Assessment by CT. 1 REVISTA DE IMAGENOLOGIA- EII / Vol. XVI / Num. 2 Imaging iconography of gallbladder cancer. Assessment by CT. Doctors Crisci, Alejandro (1); Landó, Fernando.(2). CASMU CT Department Hospital of Tacuarembó

More information

METASTASES FROM GASTRIC CARCINOMA TO COLON LESIONS: A CASE REPORT IN THE FORM OF MULTIPLE FLAT ELEVATED CASE PRESENTATION

METASTASES FROM GASTRIC CARCINOMA TO COLON LESIONS: A CASE REPORT IN THE FORM OF MULTIPLE FLAT ELEVATED CASE PRESENTATION H.C. Lee, M.T. Yang, K.Y. Lin, et al METASTASES FROM GASTRIC CARCINOMA TO COLON IN THE FORM OF MULTIPLE FLAT ELEVATED LESIONS: A CASE REPORT Hsi-Chang Lee, Min-Ta Yang, 1 Kuang-Yang Lin, 1 Hsing-Yang Tu,

More information

The Whipple Operation Illustrations

The Whipple Operation Illustrations The Whipple Operation Illustrations Fig. 1. Illustration of the sixstep pancreaticoduodenectomy (Whipple operation) as described in a number of recent text books by Dr. Evans. The operation is divided

More information

Fig. 1. Ileal and jejunal metastases from adenocarcinoma of the lung in 62-year-old male with a clinical history of bloody stool. A.

Fig. 1. Ileal and jejunal metastases from adenocarcinoma of the lung in 62-year-old male with a clinical history of bloody stool. A. 507 A B Fig. 1. Ileal and jejunal metastases from adenocarcinoma of the lung in 62-year-old male with a clinical history of bloody stool. A. An intraluminal polypoid mass (arrow) is seen in the dilated

More information

Exploring Anatomy: the Human Abdomen

Exploring Anatomy: the Human Abdomen Exploring Anatomy: the Human Abdomen PERITONEUM AND PERITONEAL CAVITY PERITONEUM The peritoneum is a thin serous membrane that lines the abdominal cavity and covers, in variable amounts, the viscera within

More information

Intraductal papillary mucinous neoplasm of the bile ducts: a rare form of premalignant lesion of invasive cholangiocarcinoma

Intraductal papillary mucinous neoplasm of the bile ducts: a rare form of premalignant lesion of invasive cholangiocarcinoma Intraductal papillary mucinous neoplasm of the bile ducts: a rare form of premalignant lesion of invasive cholangiocarcinoma Authors: R. Revert Espí, Y. Fernandez Nuñez, I. Carbonell, D. P. Gómez valencia,

More information

د. عصام طارق. Objectives:

د. عصام طارق. Objectives: GI anatomy Lecture: 5 د. عصام طارق Objectives: To describe anatomy of stomach, duodenum & pancreas. To list their main relations. To define their blood & nerve supply. To list their lymph drainage. To

More information

Normal Sonographic Anatomy

Normal Sonographic Anatomy hapter 2:The Liver DUNSTAN ABRAHAM Normal Sonographic Anatomy Homogeneous, echogenic texture (Figure 2-1) Measures approximately 15 cm in length and 10 12.5 cm anterior to posterior; measurement taken

More information

LOOKING FOR AIR IN ALL THE WRONG PLACES Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, IL

LOOKING FOR AIR IN ALL THE WRONG PLACES Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, IL SIGNIFICANCE OF EXTRALUMINAL ABDOMINAL GAS: LOOKING FOR AIR IN ALL THE WRONG PLACES Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, IL SCBT/MR 2012 October 26,

More information

Appendix 9: Endoscopic Ultrasound in Gastroenterology

Appendix 9: Endoscopic Ultrasound in Gastroenterology Appendix 9: Endoscopic Ultrasound in Gastroenterology This curriculum is intended for clinicians who perform endoscopic ultrasonography (EUS) in gastroenterology. It includes standards for theoretical

More information

Anatomy: Know Your Abdomen

Anatomy: Know Your Abdomen Anatomy: Know Your Abdomen Glossary Abdomen - part of the body below the thorax (chest cavity); separated by the diaphragm. Anterior - towards the front of the body. For example, the umbilicus is anterior

More information

General Data. Gender : Male Birthday and age : 12/07/24,80 y/o Occupation : 無 Date of Admission :

General Data. Gender : Male Birthday and age : 12/07/24,80 y/o Occupation : 無 Date of Admission : General Data Gender : Male Birthday and age : 12/07/24,80 y/o Occupation : 無 Date of Admission : 92-07-09 1 Chief complaint Upper abdominal fullness 30 minutes after having foods with sometimes epigastralgia

More information

Hilar cholangiocarcinoma. Frank Wessels, Maarten van Leeuwen, UMCU utrecht

Hilar cholangiocarcinoma. Frank Wessels, Maarten van Leeuwen, UMCU utrecht Hilar cholangiocarcinoma Frank Wessels, Maarten van Leeuwen, UMCU utrecht Content Anatomy Biliary strictures (Hilar) Cholangiocarcinoom Staging Biliary tract 1 st order Ductus hepatica dextra Ductus hepaticus

More information

Gastric Cancer Histopathology Reporting Proforma

Gastric Cancer Histopathology Reporting Proforma Gastric Cancer Histopathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.01). S1.01 Identification Family name Given name(s) Date of birth Sex Male Female Intersex/indeterminate

More information

Surface Anatomy. Location Shape Weight Role of Five Surfaces Borders Fissures Lobes Peritoneal Lig

Surface Anatomy. Location Shape Weight Role of Five Surfaces Borders Fissures Lobes Peritoneal Lig The Liver Functions Bile production and secretion Detoxification Storage of glycogen Protein synthesis Production of heparin and bile pigments Erythropoiesis (in fetus) Surface Anatomy Location Shape Weight

More information

Pancreas Quizzes c. Both A and B a. Directly into the blood stream (not using ducts)

Pancreas Quizzes c. Both A and B a. Directly into the blood stream (not using ducts) Pancreas Quizzes Quiz 1 1. The pancreas produces hormones. Which type of hormone producing organ is the pancreas? a. Endocrine b. Exocrine c. Both A and B d. Neither A or B 2. Endocrine indicates hormones

More information

CT of the Abdominal Wall

CT of the Abdominal Wall 1207 CT of the Abdominal Wall PhilipGoodma& 2 and Bharat Raval1 CT is an excellent method for evaluating the abdominal wall. Various abnormalities including hernia, hematoma, abscess, tumor, and neuromuscular

More information

Journal of Medical Imaging and Radiation Oncology

Journal of Medical Imaging and Radiation Oncology Journal of Medical Imaging and Radiation Oncology 62 (2018) 504 511 MEDICAL IMAGING PICTORIAL ESSAY Imaging in pancreas transplantation complications: Temporal classification Paula Gallego Ferrero and

More information

To describe the liver. To list main structures in porta hepatis.

To describe the liver. To list main structures in porta hepatis. GI anatomy Lecture: 6 د. عصام طارق Objectives: To describe the liver. To list main structures in porta hepatis. To define portal system & portosystemic anastomosis. To list parts of biliary system. To

More information

Gastrointestinal Tract Cancer

Gastrointestinal Tract Cancer Gastrointestinal Tract Cancer Tumors of the Stomach Gastric adenocarcinoma Incidence and Epidemiology Incidence mortality rates USA High incidence: Japan, China, Chile, Ireland risk lower socioeconomic

More information

Accessory Glands of Digestive System

Accessory Glands of Digestive System Accessory Glands of Digestive System The liver The liver is soft and pliable and occupies the upper part of the abdominal cavity just beneath the diaphragm. The greater part of the liver is situated under

More information

Preview from Notesale.co.uk Page 1 of 34

Preview from Notesale.co.uk Page 1 of 34 Abdominal viscera and digestive tract Digestive tract Abdominal viscera comprise majority of the alimentary system o Terminal oesophagus, stomach, pancreas, spleen, liver, gallbladder, kidneys, suprarenal

More information

ACUTE PANCREATITIS: NEW CLASSIFICATION OF AN OLD FOE. T Barrow, A Nasrullah, S Liong, V Rudralingam, S A Sukumar

ACUTE PANCREATITIS: NEW CLASSIFICATION OF AN OLD FOE. T Barrow, A Nasrullah, S Liong, V Rudralingam, S A Sukumar ACUTE PANCREATITIS: NEW CLASSIFICATION OF AN OLD FOE T Barrow, A Nasrullah, S Liong, V Rudralingam, S A Sukumar LEARNING OBJECTIVES q Through a series of cases illustrate the updated Atlanta symposium

More information

In the name ofgod. Abdomen 3. Dr. Zahiri

In the name ofgod. Abdomen 3. Dr. Zahiri In the name ofgod Abdomen 3 Dr. Zahiri Peritoneum Peritoneum It is the serous membrane(a type of loose connective tissue and is covered by mesothelium) that lines the abdominal cavity. Extensions of the

More information

Common and unusual CT and MRI manifestations of pancreatic adenocarcinoma: a pictorial review

Common and unusual CT and MRI manifestations of pancreatic adenocarcinoma: a pictorial review Review Article Common and unusual CT and MRI manifestations of pancreatic adenocarcinoma: a pictorial review Min-Jie Yang, Su Li, Yong-Guang Liu, Na Jiao, Jing-Shan Gong Department of Radiology, Shenzhen

More information

Lesser sac: Anatomy and non-neoplastic processes

Lesser sac: Anatomy and non-neoplastic processes Lesser sac: Anatomy and non-neoplastic processes Poster No.: C-0027 Congress: ECR 2013 Type: Educational Exhibit Authors: E. Papadaki, R. Moschona, S. Paschalidou ; Rethymno, CR/ 1 2 2 3 1 3 GR, Rethymno/GR,

More information

X-Ray Corner. Imaging of the Stomach. Pantongrag-Brown L

X-Ray Corner. Imaging of the Stomach. Pantongrag-Brown L THAI J 178 Imaging of the Stomach GASTROENTEROL 2014 X-Ray Corner Imaging of the Stomach Pantongrag-Brown L Imaging modalities used in stomach include plain radiographs, UGI study, US, CT, PET CT and MRI.

More information

M of initial surgical treatment of cancer of

M of initial surgical treatment of cancer of ATTEMPTED PALLIATION BY RADICAL SURGERY FOR PELVIC AND ABDOMINAL CARCINOMATOSIS PRIMARY IN THE OVARIES ALEXAXDER BRUNSCHWIG, M.D. UCH HAS been written about the results M of initial surgical treatment

More information

Dr. Zahiri. In the name of God

Dr. Zahiri. In the name of God Dr. Zahiri In the name of God small intestine = small bowel is the part of the gastrointestinal tract Boundaries: Pylorus Ileosecal junction Function: digestion and absorption of food It receives bile

More information

RADIOFREQUENCY ABLATION

RADIOFREQUENCY ABLATION RADIOFREQUENCY ABLATION ELIZABETH DAVID M D FRCPC VASCULAR A ND INTERVENTIONAL RADIOLOGIST SUNNYBROOK HEALTH SCIENCES CENTRE GIST GASTROINTESTINAL STROMAL TUMORS Stromal or mesenchymal neoplasms affecting

More information

8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank

8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,

More information

Guidelines, Policies and Statements D5 Statement on Abdominal Scanning

Guidelines, Policies and Statements D5 Statement on Abdominal Scanning Guidelines, Policies and Statements D5 Statement on Abdominal Scanning Disclaimer and Copyright The ASUM Standards of Practice Board have made every effort to ensure that this Guideline/Policy/Statement

More information

Limited en bloc Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition

Limited en bloc Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition 22 Limited en bloc Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition J.R. Izbicki, W.T. Knoefel, D. C. Broering ] Indications Severe dysplasia in the distal esophagus

More information

Peritoneum: Def. : It is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and clothes the viscera.

Peritoneum: Def. : It is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and clothes the viscera. Peritoneum: Def. : It is a thin serous membrane that lines the walls of the abdominal and pelvic cavities and clothes the viscera. Layers of the peritoneum: 1. Outer Layer ( Parietal Peritoneum) : lines

More information

EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY Building a European Ultrasound Community

EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY Building a European Ultrasound Community MINIMUM TRAINING REQUIREMENTS FOR THE PRACTICE OF MEDICAL ULTRASOUND IN EUROPE Appendix 9: Endoscopic Ultrasound in Gastroenterology This curriculum is intended for clinicians who perform endoscopic ultrasonography

More information

Birthday: 1952/07/31 Date of admission:1999/12/30 Age:48 y/o Past medication:esrd under regular HD for 5+ years; denied DM and HTN

Birthday: 1952/07/31 Date of admission:1999/12/30 Age:48 y/o Past medication:esrd under regular HD for 5+ years; denied DM and HTN Birthday: 1952/07/31 Date of admission:1999/12/30 Age:48 y/o Past medication:esrd under regular HD for 5+ years; denied DM and HTN Chief Complaint : 1)intermittent LLQ cramping pain for 2 months 2) LGI

More information

Development of pancreas and Small Intestine. ANATOMY DEPARTMENT DR.SANAA AL-AlSHAARAWY DR.ESSAM Eldin Salama

Development of pancreas and Small Intestine. ANATOMY DEPARTMENT DR.SANAA AL-AlSHAARAWY DR.ESSAM Eldin Salama Development of pancreas and Small Intestine ANATOMY DEPARTMENT DR.SANAA AL-AlSHAARAWY DR.ESSAM Eldin Salama OBJECTIVES At the end of the lecture, the students should be able to : Describe the development

More information

Pancreas & Biliary System. Dr. Vohra & Dr. Jamila

Pancreas & Biliary System. Dr. Vohra & Dr. Jamila Pancreas & Biliary System Dr. Vohra & Dr. Jamila 1 Objectives At the end of the lecture, the student should be able to describe the: Location, surface anatomy, parts, relations & peritoneal reflection

More information

Pancreas Case Scenario #1

Pancreas Case Scenario #1 Pancreas Case Scenario #1 An 85 year old white female presented to her primary care physician with increasing abdominal pain. On 8/19 she had a CT scan of the abdomen and pelvis. This showed a 4.6 cm mass

More information

A Case of Colon Cancer Metastasizing to the Spleen

A Case of Colon Cancer Metastasizing to the Spleen Jpn. J. Clin. Oncol. J984, 14 (3), 425 ~ 430 A Case of Colon Cancer Metastasizing to the Spleen SEISHIRO INABA, M.D., TSUGUO TANAKA, M.D., H1SAKAZU YAMAGISHI, M.D., KIMIO IGUCHI, M.D., HIDEAKI KURIOKA,

More information

OFCCR CLINICAL DIAGNOSIS AND TREATMENT FORM

OFCCR CLINICAL DIAGNOSIS AND TREATMENT FORM OFCCR CLINICAL DIAGNOSIS AND TREATMENT FORM Name: _, OFCCR # _ OCGN # _ OCR Group # _ HIN# Sex: MALE FEMALE UNKNOWN Date of Birth: DD MMM YYYY BASELINE DIAGNOSIS & TREATMENT 1. Place of Diagnosis: Name

More information

STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 3. October 16, 2015

STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 3. October 16, 2015 STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 3 October 16, 2015 PART l. Answer in the space provided. (12 pts) 1. Identify the structures. (2 pts) A. B. A B C. D. C D 2. Identify the structures. (2

More information

Unusual manifestations of peptic

Unusual manifestations of peptic Unusual manifestations of peptic ulcer disease William M. Thompson, M.D. George Norton, M.D.* Frederick M. Kelvin, F.R.C.R., M.R.C.P. R. Kristina Gedgaudas, M.D. Robert A. Halvorsen, M.D. Reed P. Rice,

More information

Pitfalls in the CT diagnosis of appendicitis

Pitfalls in the CT diagnosis of appendicitis The British Journal of Radiology, 77 (2004), 792 799 DOI: 10.1259/bjr/95663370 E 2004 The British Institute of Radiology Pictorial review Pitfalls in the CT diagnosis of appendicitis 1 C D LEVINE, 2 O

More information

The peritoneum. Prof. Oluwadiya KS, MBBS, FMCS(Orthop) Website:

The peritoneum. Prof. Oluwadiya KS, MBBS, FMCS(Orthop) Website: The peritoneum Prof. Oluwadiya KS, MBBS, FMCS(Orthop) Website: http://oluwadiya.com The peritoneum Serous membrane that lines the abdominopelvic cavity and invests the viscera The largest serous membrane

More information

Mousa Salah. Dr. Mohammad Al. Mohtasib. 1 P a g e

Mousa Salah. Dr. Mohammad Al. Mohtasib. 1 P a g e 8 Mousa Salah Dr. Mohammad Al. Mohtasib 1 P a g e In the previous lecture we talked about the peritoneum, and we said that the peritonium is a serous sac, and it consists of two layers, visceral and parietal.

More information

- Tamara Wahbeh. - Fareed Khdair. 0 P a g e

- Tamara Wahbeh. - Fareed Khdair. 0 P a g e -1 - Tamara Wahbeh - - Fareed Khdair 0 P a g e GI Embryology Note: I included everything in the records and slides; anything in the slide not included in this sheet was not mentioned by the doctor during

More information

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis Hyun-Jung Jang, MD 1,2 Won Jae Lee, MD 1 Soon Jin Lee, MD 1 Seung Hoon

More information

Abstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 Final Pathology:

Abstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 Final Pathology: Abstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 A 74 year old male with a history of GERD presents complaining of dysphagia. An esophagogastroduodenoscopy

More information

Complications after laparoscopic gastric bypass for morbid obesity. Background LGBP. Eirik Hornes Halvorsen, MD, PhD Oslo

Complications after laparoscopic gastric bypass for morbid obesity. Background LGBP. Eirik Hornes Halvorsen, MD, PhD Oslo Complications after laparoscopic gastric bypass for morbid obesity Eirik Hornes Halvorsen, MD, PhD Oslo 20.05.2015 Background Ca 3000 patients are surgically treated for morbid obesity in Norway each year.

More information

Which Blunt Trauma Patients Should Be Studied by Abdominal CT?

Which Blunt Trauma Patients Should Be Studied by Abdominal CT? MDCT of Bowel and Mesenteric Injury: How Findings Influence Management 4 th Nordic Trauma Radiology Course 2006 4 th Nordic Trauma Radiology Course 2006 Stuart E. Mirvis, M.D., FACR Department of Radiology

More information

PANCREAS DUCTAL ADENOCARCINOMA PDAC

PANCREAS DUCTAL ADENOCARCINOMA PDAC CONTENTS PANCREAS DUCTAL ADENOCARCINOMA PDAC I. What is the pancreas? II. III. IV. What is pancreas cancer? What is the epidemiology of Pancreatic Ductal Adenocarcinoma (PDAC)? What are the risk factors

More information

Lesions of the pancreaticoduodenal groove, a pictorial review

Lesions of the pancreaticoduodenal groove, a pictorial review Lesions of the pancreaticoduodenal groove, a pictorial review Poster No.: C-2131 Congress: ECR 2013 Type: Educational Exhibit Authors: E. Ni Mhurchu, L. Lavelle, I. Murphy, S. Skehan ; IE, Dublin/ IE Keywords:

More information

SURGICAL MANAGEMENT OF GASTRIC CANCER

SURGICAL MANAGEMENT OF GASTRIC CANCER SURGICAL MANAGEMENT OF GASTRIC CANCER Irina Kovatch, PGY 4 Kings County Medical Center Morbidity and Mortality January 13, 2011 Case Presentation 60 yo M admitted to medicine on 10/24/2010 with c/o persistent

More information

Case Scenario 1. The patient has now completed his neoadjuvant chemoradiation and has been cleared for surgery.

Case Scenario 1. The patient has now completed his neoadjuvant chemoradiation and has been cleared for surgery. Case Scenario 1 July 10, 2010 A 67-year-old male with squamous cell carcinoma of the mid thoracic esophagus presents for surgical resection. The patient has completed preoperative chemoradiation. This

More information

Gastrointestinal Tract. Anatomy of GI Tract. Anatomy of GI Tract. (Effective February 2007) (1%-5%)

Gastrointestinal Tract. Anatomy of GI Tract. Anatomy of GI Tract. (Effective February 2007) (1%-5%) Gastrointestinal Tract (Effective February 2007) (1%-5%) Anatomy of GI Tract Esophagus bulls-eye or target EG junction seen on sagittal scan posterior to left lobe of liver and anterior to aorta Anatomy

More information

The jejunum and the Ileum. Prof. Oluwadiya KS

The jejunum and the Ileum. Prof. Oluwadiya KS The jejunum and the Ileum Prof. Oluwadiya KS www.oluwadiya.siteled.com Introduction Introduction The small intestine (SI) comprises of the duodenum, jejunum and the ileum The jejunum is the second part

More information

Abdomen and Pelvis CT (1) By the end of the lecture students should be able to:

Abdomen and Pelvis CT (1) By the end of the lecture students should be able to: RAD 451 Abdomen and Pelvis CT (1) By the end of the lecture students should be able to: State the common indications for Abdomen and pelvis CT exams Identify possible contra indications for Abdomen and

More information

STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 3. October 17, 2014

STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 3. October 17, 2014 STRUCTURAL BASIS OF MEDICAL PRACTICE EXAMINATION 3 October 17, 2014 PART l. Answer in the space provided. (12 pts) 1. Identify the structures. (2 pts) A. B. A B C. D. C D 2. Identify the structures. (2

More information

Anatomical and Functional MRI of the Pancreas

Anatomical and Functional MRI of the Pancreas Anatomical and Functional MRI of the Pancreas MA Bali, MD, T Metens, PhD Erasme Hospital Free University of Brussels Belgium mbali@ulb.ac.be Introduction The use of MRI to investigate the pancreas has

More information

Pathways of Regional Spread in Pancreatic Cancer

Pathways of Regional Spread in Pancreatic Cancer Pathways of Regional Spread in Pancreatic Cancer 12 Chusilp Charnsangavej, M.D. Regional spread of pancreatic ductal adenocarcinoma is common at the time of diagnosis, and it is often associated with poor

More information

CT abdomen and pelvis

CT abdomen and pelvis CT abdomen and pelvis General indications: Assessment of vague abdominal symptoms (pain, colics,distenstion,...) Varifecation of a lesion discovered by other diagnostic modalities as US, barium,ivp, Staging

More information

-12. -Renad Habahbeh. -Dr Mohammad mohtasib

-12. -Renad Habahbeh. -Dr Mohammad mohtasib -12 -Renad Habahbeh - -Dr Mohammad mohtasib The Gallbladder -The gallbladder has a body, a fundus (a rounded end), a neck, Hartmann s pouch before the neck and a cystic duct that meets the common hepatic

More information

Abdomen Sonography Examination Content Outline

Abdomen Sonography Examination Content Outline Abdomen Sonography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 Anatomy, Perfusion, and Function Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy

More information

Duodenum retroperitoneal

Duodenum retroperitoneal Duodenum retroperitoneal C shaped Initial region out of stomach into small intestine RETROperitoneal viscus Superior 1 st part duodenal cap ; moves upwards and backwards to lie on the R crura medial to

More information

Small Plicae Circularis. Short Closely packed together. Sparse, completely absent at distal part Lymphoid Nodule

Small Plicae Circularis. Short Closely packed together. Sparse, completely absent at distal part Lymphoid Nodule Intestines Differences Between Jejunum and Ileum Types Jejunum Ileum Color Deeper red Paler pink Calibre Bigger Smaller Thickness of wall Thick and Heavy Thin and Lighter Vascularity Highly vascularised

More information

Peritoneum: Anatomy, physiology and pathology

Peritoneum: Anatomy, physiology and pathology Peritoneum: Anatomy, physiology and pathology Poster No.: C-417 Congress: ECR 2009 Type: Educational Exhibit Topic: Abdominal and Gastrointestinal Authors: C. L. Fernandez Rey, I. Gutierrez Lopez, E. Montes

More information

Contrast-Enhanced CT for Differentiation of Ovarian Metastasis from Gastrointestinal Tract Cancer: Stomach Cancer Versus Colon Cancer

Contrast-Enhanced CT for Differentiation of Ovarian Metastasis from Gastrointestinal Tract Cancer: Stomach Cancer Versus Colon Cancer CT of Ovarian Metastasis Women s Imaging Clinical Observations WOMEN S IMAGING Hyuck Jae Choi 1 Joo-Hyuk Lee 1 Sokbom Kang 2 Sang-Soo Seo 2 Joon-Il Choi 1 Sun Lee 3 Sang-Yoon Park 2 Choi HJ, Lee JH, Kang

More information

Imaging findings in complications of bariatric surgery.

Imaging findings in complications of bariatric surgery. Imaging findings in complications of bariatric surgery. Poster No.: C-1791 Congress: ECR 2012 Type: Educational Exhibit Authors: A. Fernandez Alfonso, G. Anguita Martinez, D. C. Olivares Morello, C. García

More information

Pathology of Intestinal Obstruction. Dr. M. Madhavan, MBBS., MD., MIAC, Professor of Pathology Saveetha Medical College

Pathology of Intestinal Obstruction. Dr. M. Madhavan, MBBS., MD., MIAC, Professor of Pathology Saveetha Medical College Pathology of Intestinal Obstruction Dr. M. Madhavan, MBBS., MD., MIAC, Professor of Pathology Saveetha Medical College Pathology of Intestinal Obstruction Objectives list the causes of intestinal obstruction

More information

IMAGING GUIDELINES - COLORECTAL CANCER

IMAGING GUIDELINES - COLORECTAL CANCER IMAGING GUIDELINES - COLORECTAL CANCER DIAGNOSIS The majority of colorectal cancers are diagnosed on colonoscopy, with some being diagnosed on Ba enema, ultrasound or CT. STAGING CT chest, abdomen and

More information

Curious case of Misty Mesentery

Curious case of Misty Mesentery Curious case of Misty Mesentery Poster No.: C-1385 Congress: ECR 2015 Type: Authors: Keywords: DOI: Educational Exhibit T. Simelane 1, H. Khosa 2, N. Ramesh 2 ; 1 Dublin/IE, 2 Portlaoise/IE Abdomen, Anatomy,

More information

COLORECTAL CANCER STAGING in 2010

COLORECTAL CANCER STAGING in 2010 COLORECTAL CANCER STAGING in 2010 Robert A. Halvorsen, MD, FACR MCV Hospitals / VCU Medical Center Richmond, Virginia I do not have any relevant financial relationships with any commercial interests COLON

More information

Fareed Khdair, MD Assistant Professor Chief, Section of Pediatric Gastroenterology, Hepatology, and Nutrition University of Jordan School of Medicine

Fareed Khdair, MD Assistant Professor Chief, Section of Pediatric Gastroenterology, Hepatology, and Nutrition University of Jordan School of Medicine Fareed Khdair, MD Assistant Professor Chief, Section of Pediatric Gastroenterology, Hepatology, and Nutrition University of Jordan School of Medicine Outline Lecture one : Gut formation Foregut: esophagus,

More information

Arteriovenostomy for renal dialysis 39.27, 39.42

Arteriovenostomy for renal dialysis 39.27, 39.42 Surgery categories NHSN Surgery codes (Reference: NHSN Operative Procedure Category Mappings to ICD-9-CM Codes, October 2010 www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf) Operative aortic aneurysm

More information

Imaging of the cisterna chyli on PET-CT in patients with known malignancy: Report of two cases

Imaging of the cisterna chyli on PET-CT in patients with known malignancy: Report of two cases Imaging of the cisterna chyli on PET-CT in patients with known malignancy: Report of two cases Natalie Burns, B.S., Jason Barksdale, M.D., Linh Ho, M.D., and Patrick M. Colletti, M.D. Citation: Burns N,

More information

OPERATIVE TREATMENT OF ULCER DISEASE

OPERATIVE TREATMENT OF ULCER DISEASE Página 1 de 8 Copyright 2001 Lippincott Williams & Wilkins Greenfield, Lazar J., Mulholland, Michael W., Oldham, Keith T., Zelenock, Gerald B., Lillemoe, Keith D. Surgery: Scientific Principles & Practice,

More information

Stomach Computerized Tomography indications, technique, examples. VUH SK Radiology and nuclear medicine center Radiologist Dileta Rutkauskaitė

Stomach Computerized Tomography indications, technique, examples. VUH SK Radiology and nuclear medicine center Radiologist Dileta Rutkauskaitė Stomach Computerized Tomography indications, technique, examples VUH SK Radiology and nuclear medicine center Radiologist Dileta Rutkauskaitė Stomach Computerized Tomography gastroente rologist Oncologist

More information

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management. Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician

More information

Afferent Loop Syndrome After Subtotal Gastrectomy With Billroth-II Reconstruction: Etiology and Treatment

Afferent Loop Syndrome After Subtotal Gastrectomy With Billroth-II Reconstruction: Etiology and Treatment Int Surg 2016;101:194 200 DOI: 10.9738/INTSURG-D-15-00137.1 Afferent Loop Syndrome After Subtotal Gastrectomy With Billroth-II Reconstruction: Etiology and Treatment Sung-Heun Kim 1, Jong-Young Oh 2, Ki-Han

More information

Staging Colorectal Cancer

Staging Colorectal Cancer Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for

More information

Anatomy of the Large Intestine

Anatomy of the Large Intestine Large intestine Anatomy of the Large Intestine 2 Large Intestine Extends from ileocecal valve to anus Length = 1.5-2.5m = 5 feet Regions Cecum = 2.5-3 inch Appendix= 3-5 inch Colon Ascending= 5 inch Transverse=

More information

MDCT signs differentiating retroperitoneal and intraperitoneal lesions- diagnostic pearls

MDCT signs differentiating retroperitoneal and intraperitoneal lesions- diagnostic pearls MDCT signs differentiating retroperitoneal and intraperitoneal lesions- diagnostic pearls Poster No.: C-0987 Congress: ECR 2015 Type: Educational Exhibit Authors: D. V. Bhargavi, R. Avantsa, P. Kala; Bangalore/IN

More information

INFORMATION ON PANCREATIC HEAD AND PERIAMPULLARY CANCER

INFORMATION ON PANCREATIC HEAD AND PERIAMPULLARY CANCER INFORMATION ON PANCREATIC HEAD AND PERIAMPULLARY CANCER What is Pancreas? The pancreas is a gland located in the back of your abdomen behind the stomach. pancreas is divided into four parts: the head,

More information

Topics: Staging and treatment for pancreatic cancer. Staging systems for pancreatic cancer: Differences between the Japanese and UICC systems

Topics: Staging and treatment for pancreatic cancer. Staging systems for pancreatic cancer: Differences between the Japanese and UICC systems M. J Hep Kobari Bil Pancr and S. Surg Matsuno: (1998) Staging 5:121 127 system for pancreatic cancer 121 Topics: Staging and treatment for pancreatic cancer Staging systems for pancreatic cancer: Differences

More information