Although celiac axis stenosis is a frequently encountered occlusive vascular disease, clinically significant ischemic bowel disease caused by celiac axis stenosis is rarely reported due to rich collateral circulation from the superior mesenteric artery (SMA). The most important and frequently encountered collateral vessels from the SMA in patients with celiac axis stenosis are the pancreaticoduodenal arcades and the dorsal pancreatic artery. Subtypes of collateral pathways via the dorsal pancreatic artery include a longitudinal pathway between the celiac branches and the SMA or its branches and a transverse pathway to either the splenic or gastroduodenal artery. A communicating channel between the right hepatic artery and the SMA can be a route for collateral circulation. Hepatic artery variants cause the development of unique collateral pathways that have different characteristics depending on the type of variant. These collateral pathways include intrahepatic interlobar collateral vessels, right gastric to left gastric arterial anastomoses, left hepatic to left gastric arterial anastomoses, and peribiliary arterial plexuses. Major collateral pathways in patients with celiac axis stenosis can be identified with spiral CT, and knowledge concerning this collateral circulation may be important for certain medical procedures such as interventional procedures for the management of hepatic tumors, pancreaticobiliary surgery, and liver transplantation.

The findings in this initial experience suggest that stent-graft insertion may be a safe and effective alternative to surgical treatment of aortic and arterial aneurysms in patients with Behçet disease.

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Iodide mumps, swelling of salivary glands after contrast medium injection, is a rare adverse reaction. We present a case in a 73-year-old man with advanced gastric cancer. About 10 min after a CT scan performed with intravenous injection of 140 ml of the low osmolality contrast agent Ioxaglate (Hexabrix 320, Guerbet, France), he complained of progressive swelling of the submandibular area. Ultrasound showed diffuse swelling and internal low echoic thick septa in the submandibular glands bilaterally. Approximately 1 h afterwards, the swelling of his submandibular glands started to regress and returned to normal within a day.

Objective. The purpose of this study was to evaluate the feasibility and safety of manual reduction of torsion of an intrascrotal appendage under ultrasonographic monitoring. Methods. Fifteen boys with torsion of an intrascrotal appendage, confirmed by scrotal ultrasonography and clinical status, were included in the study. The boys were 6 to 13 years old (mean age, 9 years). They all had painful, unilateral swelling of the scrotum and a palpable, tender nodule on physical examination. Scrotal ultrasonography indicated a single, variably echoic mass corresponding to the intrascrotal appendage. The mass was avascular according to Doppler ultrasonography. Thirteen boys underwent manual reduction under ultrasonographic monitoring. We tried to pull and release the swollen appendage in 8 patients and gently squeezed the appendage in 5. The procedure was considered successful when ultrasonography showed reperfusion in the appendage and the patients stated complete relief of scrotal pain. In 14 boys, follow-up scrotal ultrasonography was performed after the manual reduction. Results. Successful reduction was obtained in 12 (80.0%) of 15 boys. Only 1 boy was regarded as having reduction failure; this patient had intractable pain after the trial reduction, and ultrasonography showed transient vascular flow that promptly disappeared in the appendage. On follow-up ultrasonography, the maximal diameter ± SD of the intrascrotal appendages significantly decreased from 6.1 ± 1.2 to 4.0 ± 1.3 (P = .005) in 11 patients with successful reduction. Conclusions. Manual reduction under ultrasonographic monitoring seems to be a feasible and effective method for the treatment of torsion of an intrascrotal appendage to immediately relieve pain. Key words: scrotum; torsion; ultrasonography. Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-021, Korea. E-mail: indawn@schbc.ac.kr he most common cause of an acute painful hemiscrotum in children is torsion of an intrascrotal appendage, which accounts for 35% to 67% of cases and is generally considered more common than testicular torsion.1 The ultrasonographic findings of torsion of an intrascrotal appendage are a spherical appendage of 5 mm or larger, increased periappendiceal blood flow, and no blood flow within the torsed appendage.2,3 The internal echogenicity of a torsed intrascrotal appendage is variable, appearing hypoechoic, isoechoic, and hyperechoic to the testis. Clinical findings for establishing a diagnosis are a blue dot visible through the scrotal skin (a blue dot sign), a black dot shown by transillumination, and a tender, palpable