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Gastroduodenal artery aneurysms have a low incidence of less than 1.5% of all splanchnic aneurysms. Rupture is frequent and life-threatening. The diagnosis is made by CT scan and by coeliac angiography, which also plays a therapeutic role in stable or stabilized patients. Surgery remains the treatment of choice in case of hemodynamic instability. We reviewed the case of a ruptured aneurysm of the gastroduodenal artery mimicking a tumor of the pancreas' head in a patient who died following a hemorrhagic shock., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: Acute intestinal obstruction (AIO) is a syndrome defined by the cessation of intestinal transit caused by an obstacle or paralysis of intestinal peristalsis. It is a diagnostic and therapeutic emergency. The multi-bar CT scan has revolutionized the management of this pathology, as it allows the surgeon to answer different questions. The aim of our study was to describe the CT aspects of AIO, to determine the etiologies and to show the place of CT in the management of AIO., Material and Method: This was a retrospective descriptive study conducted over 5 years (January 2010 to December 2015) on 81 patient files collected in the imaging departments of the CHU Aristide Le Dantec and the Hôpital Principal. The files retained were those whose diagnosis was established from the clinic, imaging and/or not from surgery., Results: Mechanical occlusions represented 94.4% (76 cases) and functional occlusions 5.6% (05 cases). They were of the small bowel type in 70% of cases and colonic in 30%. The elementary lesions found were: transitional zone (36 patients), feces sign (28 patients), beak sign (06 patients), whirlpool sign (11 patients), signs of severity (36 patients). Seventy-two patients received surgery and 04 patients received medical treatment. The preoperative diagnosis was confirmed by surgery in 68 patients. Surgery corrected the diagnosis in 04 cases. Signs of severity were confirmed at surgery in all our patients., Conclusion: The CT scan has a major role in the therapeutic choice of AIO. It should be requested in first intention before an occlusive syndrome., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Objective: The objective of this work was to study the place of ultrasound in the positive diagnosis, etiology and choice of the therapeutic modality of acute intestinal intussusception., Material and Methods: This was a retrospective, descriptive, cross-sectional, multicenterstudy, carried out over a period of 18 months (January 1, 2016 to June 30, 2017) on 45 patient files collected in the radiologydepartments (Aristide Le Dantec and Albert Royer). Were included all patients aged less than 14 years, admitted with acute abdominal pain, whose diagnosis of IIA was retained on ultrasound. Pneumatic disinvagination was performed in patients without signs of severity. We studied the time of management, the ultrasound aspects of the invagination puddles, the therapeutic choice but also the radiosurgical concordance and the factors of failure of the pneumatic enema. Statistical analysis was done by SPSS version 21.0 software., Results: Ultrasound was used to make the diagnosis of IIA in 43 cases (95.5%). The sonographic characteristics were as follows: 27.9% of the IIA were located in the right hypochondrium, 19 cases were ileo-caecal, 10 (22.2%) ileo-caeco-colic, 9 (20%) ileo-colic, 4 (8.9%) colo-colic and one (2.2%) gregelic; 44 cases were idiopathic and one case was a Meckel's diverticulum The management time was less than 48 hours in 34% of cases and 66% more than 48 hours. Pneumatic reduction was performed in 18 cases (40%), with success in 14 cases (77.8%) and one case of pneumoperitoneum complication. Surgery was performed in 31 cases (68.8%). The sensitivity and specificity of ultrasound in the diagnosis of signs of severity were 77.7% and 78.9%. Good agreement was observed between the results of the Doppler ultrasound and the intraoperative findings. Ultrasound parameters associated with failed pneumatic deinvagination were: outer cylinder thickness ≥10 mm, adenopathy at the level of the small-axis bladder ≥10 mm, effusion in the bladder, and hypovascularization of the bladder head. Hypovascularization of the boudin head was the only factor independently associated with failure of pneumatic disinvagination., Conclusion: Ultrasound is a powerful imaging modality in the positive diagnosis, etiology, severity and therapeutic choice of IIA., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

The abdominal pseudocyst is a rare complication that can occur in subjects with a ventriculoperitoneal drain (VPD). We report the case of an 11-year-old adolescent with congenital hydrocephalus antecedent, for whom a ventriculoperitoneal shunt was made. He presented a progressive abdominal distension without notion of transit disorders. Abdominal ultrasound and uroscanner revealed an organized peritoneal effusion of great abundance, thin and regular wall, exerting a mass effect on the bladder and the ureters responsible for bilateral uretero-hydronephrosis. Above all, it has made it possible to individualize the distal ventriculo-peritoneal bypass catheter projecting in the effusion., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Introduction: Parathroid Carcinoma is a rare cause of primary hyperparathyroidism (PPH). His diagnosis is a real challenge. We report an observation and discuss the diagnostic guidelines before surgery., Case: A 31-year-old Senegalese woman was admitted to our department for the exploration of diffuse bone pain and multiple pathological fractures. Physical examination revealed a right lateral mass of the neck. Serum calcium level was 142.2 mg / l and serum parathyroid hormone 42 N. Ultrasound and cervical tomodensitometry showed a parathyroid mass compressing the thyroid and trachea. The extension assessment revealed osteolytic lesions and T4-T5 epiduritis evoking metastases. Surgery and histology were performed. According to the histopathology and clinical context, the tumor was identified as a parathyroid carcinoma., Conclusion: The preoperative evaluation of a patient with severe hypercalcemia and high PTH levels should include the possible diagnosis of parathyroid carcinoma, especially in symptomatic patients or in case of palpable neck mass.

Inguinal hernia is frequent in children. Strangulated hernia is the main complication of this disease and it is a diagnostic and therapeutic emergency. Imaging techniques, in particular Ultrasound, play a key role in case of diagnostic doubt, especially when the hernia occurs in a context of oscillating testicles because this may mimic a torsion of the spermatic cord. Ultrasound should be used in patients with strangulated hernia associated with oscillating testicles in order to eliminate testicular ischemia.

We report a case of a 86-year old woman with Spiegel hernia complicated by occlusion whose diagnosis was based on CT scan. She was examined in the Emergency Surgery Department for brutal onset of pain in the right iliac fossa associated with vomiting. On physical examination the patient was febrile (38.2° C). It showed hard, sensitive and mobile mass located in the right iliac fossa, with respect to both planes. Abdominal CT scan showed a hernia sac with the neck measuring 13 mm in the right iliac fossa, in front of the aponeurosis of the external oblique muscle. It contained fat and a small bowel loop (curved arrow) with two zones of transition giving a double beak-like appearance at the level of the neck. CT scan showed a lack of enhancement of the wall of the loop after administration of contrast material. The diagnosis of strangulated spiegel hernia associated with sign of arterial ischemia of the digestive wall was retained. Surgery was perfomed with simple postoperative management., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

We report the case of a 67-year old patient with a personal history of inguinal hernia, presenting with a large painless bag associated with urinary disorders, similar to pollakiuria, evolving for several months. Ultrasound allowed to reveal an emptiness in the bladder bag, urinary stasis and a collection of fluid in the scrotum, evoking a hydrocele. Abdominal/pelvic CT scan showed right intrascrotal bladder associated with left direct inguinal hernia and bilateral urinary stasis. The diagnosis was confirmed by surgical exploration. The postoperative course was uneventful. Inguinoscrotal hernia containing exclusively urinary bladder is an exceptional entity. CT scan should be recommended for patients with inguinoscrotal hernia associated with urinary disorders (Mery's Sign)., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts

We report the case of a 7-year old patient presenting for acute paroxysmal abdominal pain at the level of epigastrium associated with vomiting without involving blockage of materials and gas. Clinical examination and laboratory tests were unremarkable. Abdominal ultrasound was requested as a first line investigationa and showed a right echogenic homogeneous flank and iliac fossa mass with regular contours without vascular Doppler signal and associated with "whirl sign" of mesenteric vessels. On CT scan this mass was seen as a well-defined lipoma formation, exerting a mass effect on the cecum, which was in direct contact with mesenteric volvulus. Arrangement of the mesenteric vessels at their origin was normal. The diagnosis of mesenteric volvulus associated with lipoma was retained. Surgical management and histological analysis of the surgical specimen confirmed the diagnosis. This clinical case aims to highlight the contribution of ultrasound and CT scan in the diagnosis of midgut volvulus., Competing Interests: Les auteurs déclarent ne pas avoir de conflits d'intérêts en relation avec cet article.

Slow spinal cord compressions are due to the development of an expansive lesion within the medullary canal. This is a very common condition whose diagnosis is primarily clinical. The magnetic resonance imaging occupies a central and currently irreplaceable position in diagnosis and localization as well as in etiological research. Etiology of cancer is predominant in Europe. This study aims to describe the MRI features of slow spinal cord compressions and to determine its etiologic profile. This is a retrospective study of 97 cases whose data were collected at the Department of Radiology, National University Hospital Centre (CHUN) of Fann, over a period of 30 months (from March 8, 2010 to September 29 2012). All patients referred for slow spinal compression occurred in a non traumatic context were included in the study. The average age of patients was 42.6 years, ranging between 04 months and 85 years. We studied the topography of lesions (spinal floor, ductal compartments), their enhancement and their etiological criteria. The review protocol allowed the realization of T1-weighted sequences with no injection of gado, T2-weighted sequences, STIR sequences and T2-weighted DRIVE sequences centered on lesions levels or suspicious areas. MRI allowed to determine the exact location and the extent of lesions. The involvement of the thoracic spine occurred in 42% of cases, followed by the cervical spine in 32% of cases. The lumbosacral damages and multi-stage damages were found in 18% and 8% of cases respectively. Extradural lesions were found in 87% of cases, followed by intradural extramedullary lesions in 08% of cases and intramedullary lesions in 05% of cases. The peculiarity of etiologic profile of our study is the prevalence of infectious epiduritis and the relative frequency of metastatic epiduritis compared to the Western series. The vertebral-medullary MRI occupies a crucial place in the positive, topographic and etiological diagnosis of spinal cord compressions., Competing Interests: Conflits d’intérêts Les auteurs ne déclarent aucun conflit d'intérêt.

Biliary MRI is a relatively new diagnostic test in the arsenal of exploration techniques in biliopancreatic pathology. This is a reproducible and reliable non invasive technique for direct visualization of biliary and pancreatic ducts. This study aims to evaluate the morphological features of major abnormalities and the role of biliary MRI in the etiological diagnosis of cholestatic icteruses. This is a retrospective study of 17 patients conducted in the Imaging Unit of the University Hospital of Fann and of the Principal hospital of Dakar over a period of 4 years and six months (January 2008 at July 2012). All patients underwent MRI (1.5T) according to the standardized protocols for the explored pathology. Only medical records of patients whose diagnosis was established based on laboratory tests and who underwent biliary MRI and surgical exploration were retained. The study involved 5 women and 12 men with a sex ratio of 2.4. The average age of patients was 58 years, ranging between 35 and 81 years. Klatskin tumors were found in 7 patients with infiltrative form in 71% of cases and exophytic form was found in 28% of cases. Cancers of the gallbladder were found in 28% of cases. Cancers in the head of the pancreas accounted for 28% of cases. Major bile duct lithiasis was detected in 5 patients, choledocholithiasis in 60% of cases and a single lithiasis in 40% of cases. All these lesions were responsible for an expansion of intrahepatic bile duct (IHBD). One case of intra and extrahepatic bile ducts dilatation was found without biliopancreatic cause. Biliary MRI is the test of choice for the exploration of cholestatic icteruses. It should be recommended as first-line examination when residual lithiasis is suspected and as second-line examination after ultrasound, when the latter shows a suspected bile ducts tumoral obstruction. Its association with CT scan is the best combination of screening tests for etiologic diagnosis and pre-operative assessment of tumoral biliary obstructions., Competing Interests: Conflits d’intérêts Les auteurs ne déclarent aucun conflit d'intérêt.

Wandering or migrating spleen is a rare anomaly which is usually described in children. Complications, which include pedicle torsion, are common and can be life-threatening. We report the case of a 17 year-old patient with a long past medical history of epigastric pain suffering from wandering spleen with chronic torsion of the pedicle. The clinical picture was marked by spontaneously painful epigastric mass, evolved over the past 48 hours. Abdominal ultrasound objectified heterogeneous hypertrophied ectopic spleen in epigastric position and a subcapsular hematoma. Doppler showed a torsion of splenic pedicle which was untwisted 2 turns and a small blood stream on the splenic artery. Abdominal CT scan with contrast injection showed a lack of parenchymal enhancement of large epigastric ectopic spleen and a subcapsular hematoma. The diagnosis of wandering spleen with chronic torsion of the pedicle complicated by necrosis and subcapsular hematoma was confirmed. The patient underwent splenectomy. The postoperative course was uneventful. We here discuss the contribution of ultrasound and CT scan in the diagnosis of wandering spleen with chronic torsion of the pedicle.