1/3. Counterclockwise barber-pole sign on prenatal three-dimensional power Doppler sonography in a case of duodenal obstruction without intestinal malrotation.Three-dimensional (3D) power Doppler sonographic imaging provides a 3D view of the blood vessels. This technique reportedly has advantages over other forms of sonography in visualizing normal and abnormal fetal vascular anatomy. We report the case of a 36-year-old pregnant woman in whom 3D power Doppler sonography with simultaneous gray-scale imaging was performed at 32 weeks' gestational age to investigate an intestinal obstruction in the fetus that was suspected on the basis of 2-dimensional sonographic findings. The 3D sonograms revealed that the superior mesenteric artery and vein of the fetus were wound counterclockwise, forming the "barber-pole" sign. At 38 weeks' menstrual age, the female infant was delivered vaginally. Only duodenal atresia and annular pancreas, but not intestinal malrotation, were found postnatally. Surgical reconstruction of the duodenum was performed, with no major complications. Previous research suggests that the counterclockwise barber-pole sign is a normal finding. On the basis of our case, we believe that this "negative finding" might be used to exclude the diagnosis of midgut volvulus, a condition that would be expected to cause these vessels to wrap around in a clockwise direction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/3. Ileocolic intussusception mimicking the imaging appearance of midgut volvulus as a result of extrinsic duodenal obstruction.duodenal obstruction caused by ileocolic intussusception in the absence of intestinal malrotation is extremely rare. We present and discuss the imaging findings in an infant with an intussusception secondary to a duplication cyst in whom sonography also showed inversion of the orientation of the mesenteric vessels and a distended stomach. A contrast medium study revealed a proximal duodenal obstruction with a beak appearance suggestive of midgut volvulus. At surgery, an ileocolic intussusception causing duodenal obstruction without concomitant malrotation or volvulus was found. The combination of duodenal obstruction and abnormal relationship of the mesenteric vessels as a result of ileocolic intussusception has not previously been reported in the literature.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/3. Two cases of living-related intestinal transplantation.We recently performed living-related small bowel transplant in two patients. The first patient was a 14-year-old boy with total parenteral nutrition (TPN)-dependent short-bowel syndrome associated with hypoganglionosis. He received a bowel graft from his 43-year-old mother. The second patient was a 27-year-old female who had undergone massive enterectomy due to volvulus. She underwent living-related bowel transplantation from her 57-year-old mother. In both cases, blood types were ABO identical, cytotoxic cross matches were negative, and cytomegalovirus status was positive to positive in both cases. Up to one third of the donor bowel was harvested from the distal ileum. The graft vessels were connected to infrarenal aorta and inferior vena cava. The immunosuppressive regimen consisted of daclizumab, tacrolimus, and steroids. The first patient developed progressive acute cellular rejection on postoperative day 9, requiring OKT-3 therapy. Two months after transplantation, he was weaned off TPN, tolerating oral intake with a fully functioning graft. The second patient was weaned off TPN on day 29 with a functioning graft. Her metabolic disorder dramatically improved. This patient developed indeterminate acute cellular rejection on day 111, which was successfully treated with bolus injections of steroid. Both donors had no complications; they were discharged on day 10. Living-related intestinal transplantation can be a treatment option for patients with short-bowel syndrome.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |