Search

1.1. A case of herpes zoster with ileus simulating intestinal obstruction is presented in which barium enema studies demonstrated a constant, smooth constriction in the sigmoid colon which subsequently returned to normal. 2.2. The necessity for accurate evaluation of the roentgen changes in the barium enema studies is stressed. The possibility of intestinal involvement in herpes zoster should be kept in mind in order to obviate undesirable and unnecessary surgical intervention in such cases. 3.3. It is believed in our case that the pathologic changes in the sigmoid on barium enema study may have been due to direct involvement of the sigmoid by the herpes virus, since these changes cannot be satisfactorily accounted for on the basis of reflex segmental spasm.

W IDENING OF THE LINEAR THORACIC paraspinal shadow is generally attributed to inflammatory or malignant disease having its origin in the vertebral body, disc or paravertebral soft tissue structures. Among the more common conditions associated with changes in the paraspinal shadow, especially with a paravertebral mass, are tuberculous or pyogenic abscess, metastatic or primary malignant neoplasm, including myeloma and lymphoma, hemorrhage as a result of trauma, and others. Recently, abnormalities of the paraspinal shadow have been reported in cases of anemia with extramedullary hematopoiesis.3 Brailsford’ described a case in which rupture of the aorta simulated paravertebral abscess. Otherwise, we are not aware of any report mentioning changes in the paraspinal shadow as a result of dissecting aortic aneurysm. We suspect that with the lowered incidence of tuberculous paravertebral abscess, dissecting aortic aneurysm will prove to be one of the more common conditions producing changes in the paraspinal shadow, especially once the mainfestations of para-aortic hemorrhage and its relationship to dissecting aortic aneurysm are more generally appreciated.

Volvulus of the transverse colon constitutes one of the rarest forms of mechanical obstruction of the large bowel, and reliable radiologic documentation of such an accident occurring in a normally developed colon (excluding anomalies of rotation) is indeed unusual. Kallio (10), in 1932, collected 18 cases, including 2 from his own experience, and stated that, although uncommon, volvulus of this type was possible in the presence of an extremely redundant transverse colon whose flexures were in unusually close proximity; the torsion mechanism thus was similar to that occurring in the sigmoid. Kallio furnished an excellent review of the literature and the reader is referred to his paper for references to the earlier cases. The only subsequent contributions dealing with this condition are single case reports by Groth (8) in 1934, Melchior (13) in 1934, Martin and Ward (12) in 1944, Tabanelli (18) in 1947, Olivier and Libaude (15) in 1948, Murray (14) in 1950, and a report of 2 cases by Buenger (3) in 1954. Up...

Herniation of the stomach at the site of a transverse colostomy must be rare, for no reference pertinent to its occurrence could be found on a survey of the literature. The following case illustrates the problems encountered in the diagnosis of this entity and the difficulty of its differentiation from volvulus of the right colon. A 76-year-old white female was admitted on Feb. 8, 1952, in the early evening, with symptoms of abdominal pain, distention, progressive constipation, and weight loss. Blood had been noted in the stool on one occasion about a month previously. On physical examination loops of distended bowel were visible, bowel sounds were markedly reduced, and there was diffuse abdominal tenderness. Admission scout films of the abdomen indicated a low colonic obstruction, probably neoplastic, and two hours later a transverse colostomy over a glass rod was performed. The bowel was decompressed with a needle, but not opened until the following morning. At that time moderate amounts of gaseous, flu...

1. Intramural jejunal hematomas may complicate anticoagulant therapy, mimicking the acute surgical abdomen.

Roentgenologic findings demonstrating sigmoidal fistula in a case of ovarian dermoid cyst and tubo-ovarian abscess are presented.

Volvulus of the cecum and ascending colon is not as rare as is generally assumed. The early recognition of this type of colonic obstruction is of great importance for radiologist and surgeon alike. The radiologist can make the diagnosis correctly in many instances, and on this basis the surgeon is guided to proper remedial procedures and, eventually, to prevention of a recurrence of such an accident. Bundschuh (7) collected 110 cases of cecal volvulus in 1913. For the period 1913–42, Wolfer, Beaton, and Anson (63) collected 194 cases, bringing the total to 304. Courty (11) cites an additional 75 examples from France since 1940, and a review of the readily available sources in the American and British literature since 1942 has yielded 68 cases. To these we are adding 24 new cases, 19 of which were seen in a three-year interval, making a total of 471. Volvulus of the cecum and ascending colon represents a type of mechanical obstruction of the proximal half of the colon, presupposing inadequate fixation of a...

Roentgenographic recognition of carcinoma of the biliary ducts preoperatively is seldom possible. In the case to be reported here, a diagnosis of scirrhous neoplastic involvement of the entire common duct, as well as of the right and left hepatic ducts, was made following a percutaneous cholangiographic study. This diagnosis was substantiated at surgery, and a detailed roentgenographicpathologic correlation was possible as a result of autopsy study. The extent of involvement of the duct system, especially extension of the tumor into the porta hepatis, with involvement of the right and left hepatic ducts, permitted us to foresee failure of any contemplated surgical procedure for alleviation of the patient's jaundice. It is possible that, under different circumstances, one might be able to predict the type of operation necessary to carry out successfully a shunt procedure of the obstructed biliary duct system. Case History C. T., a 66-year-old white woman, was admitted March 28, 1957, with a persistent pain...