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Robotic trachelectomy after neoadjuvant chemotherapy with simultaneous tubal anastomosis may be an option in stage IB2 cervical cancer patients., Introduction: The aim of this study was to report a case of cervical cancer stage IB2 treated with neoadjuvant chemotherapy, followed by simultaneous robotic-assisted radical trachelectomy and reversal of tubal sterilization. Case Description: This case occurred in a university hospital involving a 31-y-old woman with stage IB2 cervical cancer treated using neoadjuvant chemotherapy, robotic surgery, and tubal anastomosis to determine cancer disease status and achieve restoration of tubal patency. Discussion: A successful radical trachelectomy with patent tubes was done bilaterally. Cancer and fertility procedures can be simultaneously implemented and achieved.

During a double-contrast barium enema the radiologist interacts with the patient, the controls of the fluoroscope, and the image on the television monitor. The radiologist paints an image of the colon; the barium is the paint, the colon is the canvas. The radiologist manipulates the barium pool, the air column, and the patient to create images. Although the radiologist may have a plan going into the examination, the game plan is altered by the patient's ability to tolerate and perform the study, the length of the colon, and pathology encountered. If the radiologist understands the goals to be achieved, the studied can be tailored to fit what is happening in the fluoroscopic suite.

Secretin causes temporary dilatation of pancreatic ducts, principally by increasing pancreatic exocrine secretions, and thus allows better visualization of the ducts at magnetic resonance (MR) cholangiopancreatography. Secretin-enhanced MR cholangiopancreatography is useful for detection and diagnosis of a variety of congenital, inflammatory, and neoplastic conditions of the pancreas. Although MR cholangiopancreatography without secretin is a reliable method for evaluating the pancreatobiliary ductal system, the authors believe that secretin-enhanced MR cholangiopancreatography gives additional valuable functional and anatomic information about the pancreatic duct and pancreatic excretory capacity.

OBJECTIVE. Our objective was to report the CT features of biliopancreatic limb (afferent loop) obstruction.CONCLUSION. Acute biliopancreatic limb obstruction has typical CT features. Given its high morbidity and rate of reoperation, it is useful to make this specific diagnosis instead of reporting the findings as postoperative small bowel obstruction.

OBJECTIVE. The objective of our study was to differentiate the CT findings of gelatin bioabsorbable sponges used as hemostatic agents from postoperative abdominal abscess.CONCLUSION. Gelatin absorbable sponge may mimic a postoperative abscess on CT. Findings that may help differentiate the hemostatic agent from abscess include linear arrangement of tightly packed gas bubbles, fixed position of gas bubbles on subsequent examinations, shape, lack of air–fluid level, and lack of enhancing wall.

Purpose: The lack of ductal continuity between a viable pancreatic tissue and the gastrointestinal tract results in the disconnected pancreatic duct syndrome (DPDS). The purpose of our study is to describe accurately the imaging features of CT scanning and endoscopic retrograde pancreatography (ERCP) that define the DPDS. Methods: We conducted a retrospective analysis of the computed tomography (CT) and ERCP examinations in 26 consecutive patients with surgically proven disconnected pancreatic ducts treated over a 5-year period at our institution. Two abdominal radiologists concurrently defined the imaging features (presence and size of fluid collection along the course of the pancreatic duct, upstream enhancing pancreatic parenchyma, and ERCP abnormalities) via consensus for both exams. Patient demographic , etiology of pancreatitis, surgical treatment, initial CT interpretation, and the delay between symptom onset to correct diagnosis were recorded. Results: A discrete, intrapancreatic fluid collection (average size = 27 cm 2 (range, 4-74 cm 2 ) along the course of the main pancreatic duct with upstream viable pancreatic parenchyma was identified by CT in 26 cases. ERCP showed ductal obstruction at the level of the intrapancreatic fluid collection in all patients with extravasation of contrast in 14 (54%). All patients were treated by operation: 15 (58%) by internal drainage into a Roux-en-Y limb of jejunum and 11 (42%) by distal pancreatic resection. No prior CT interpretation correctly identified DPDS. The average delay between symptom onset and definitive diagnosis was 9.3 months (range, 3-36 months). Conclusions: A discrete intrapancreatic fluid collection along the expected course of the main pancreatic duct with viable upstream pancreatic parenchyma suggests the diagnosis of DPDS. ERCP findings of ductal obstruction at the level of this fluid collection with or without contrast extravasation confirm this diagnosis. Treatment is surgical and requires either internal drainage or distal pancreatic resection for complete resolution.

IMAGING HIGHLIGHTS □ Small bowel malignant tumors are rare, accounting for 1 to 2% of cancers of the gastrointestinal (GI) tract.

To evaluate the effectiveness of glucagon and diazepam as compared with placebo in decreasing abdominal discomfort in patients during double-contrast barium enema examination.Thirty-six men (n = 9) and women (n = 27) aged 21-62 years with "a lot or terrible discomfort" during double-contrast barium enema examination were randomized into double-blind groups of 12 patients each at the onset of examination. Each group received a placebo, glucagon (1 mg), or diazepam (5 mg) intravenously. Discomfort was scored on a four-point scale by the patients.Repeated measures analysis of variance findings indicated that those who received an active drug reported significantly (P = .001) greater relief of discomfort. Discomfort scores improved, on average, 2.2 in the glucagon, 2.0 in the diazepam, and 1.2 in the placebo groups. Colonic spasm did not correlate with abdominal discomfort.Discomfort during double-contrast barium enema examination can be statistically significantly diminished with a hypotonic agent or a sedative.

In a prospective study, the effect of infusion of a low-density contrast material was evaluated as an adjunct to high-density, double-contrast imaging of the sigmoid colon. After double-contrast barium enema (DCBE) study, 52 consecutive patients with sigmoid diverticulosis received an additional 500-750-mL enema either with water or a 1.5% barium suspension for computed tomography. Rectosigmoid radiographs were evaluated for luminal distention, visualization of the interhaustral space, definition of diverticula, and interpretation of polypoid defects. While double-contrast views were excellent in 21% of patients, improvement in multiple factors by water or 1.5% barium flush resulted in improved sigmoid images in 65% and 75% of patients, respectively. Polyps were confirmed and artifactual defects confidently excluded. Sigmoid flush, particularly with low-density barium, is a simple adjunct to DCBE study that improves visualization of the diverticular sigmoid and increases interpretive confidence.