Idiopathic localised dilatation of the ileum is a rare condition in which one or more segments of the ileum are dilated with abrupt transition to normal segments proximally and distally. To the best of our knowledge, this is the first case report to describe the findings and highlight the potential advantages of computed tomography enteroclysis to assess this condition.

A suspected retained foreign body in soft tissue following penetrating injury presents a diagnostic challenge to clinicians. A retained foreign body can be radiolucent and is prone to be missed, leading to serious complications. Ultrasonography is a reliable tool to detect, localise, and guide removal of a foreign body, and also to diagnose injury-related conditions in cases where no foreign body is detected. This pictorial essay illustrates the spectrum of findings encountered during ultrasonographic examination for suspected foreign bodies. Familiarisation with these findings may help in diagnosis and guide further management.

Objectives: To determine the diagnostic accuracy and predictive values of hepatobiliary scintigraphy and sonography in the evaluation of clinically suspected biliary atresia. Methods: All infants who underwent hepatobiliary scintigraphies for suspected biliary atresia within a 3-year period (2006-2008) in the New Territories East Cluster of Hong Kong were retrospectively analysed. All scintigraphies and peri-scintigraphic ultrasound images were reviewed for signs suggestive of biliary atresia. The accuracy of imaging studies was determined by surgical findings and clinical follow-up. Results: Forty-two cases were retrieved with two excluded due to incomplete clinical records. Seven (18%) of 40 patients had surgically confirmed biliary atresia; all of these had positive scintigraphies and 6/7 (86%) had positive sonographic findings. Among the 40 scintigraphies, there were 7 true-positive, 28 true-negative, and 5 false-positive studies. The scintigraphic sensitivity, specificity, and positive and negative predictive values were 100%, 85%, 58% and 100%, respectively. Among the 5 false-positive scintigraphies caused by hepatic dysfunction, 3 had normal sonography; 2 became negative on repeated scintigraphy, 2 had spontaneous clinical improvement, and 1 had normal intra-operative cholangiography. Thirty-eight of the 40 patients had performed peri-scintigraphic sonography. There were 23/38 (61%) abnormal studies which included cases with small gallbladder (n = 15) and non-visualised gallbladder (n = 8), but not periportal fibrosis. The sensitivity, specificity, positive and negative predictive values of these sonograms were 86%, 45%, 27% and 93%, respectively. Conclusions: Both hepatobiliary scintigraphy and sonography are currently the standard imaging investigations for suspected biliary atresia. This study revealed relatively low positive predictive value for biliary atresia by either investigation. We therefore consider their complementary role in which a correlation between scintigraphy and sonography is important, and recommend follow-up imaging reassessment before making definitive surgical decisions. This will serve to decrease the frequency of false-positive imaging diagnoses of biliary atresia, and hence, avoid unnecessary surgeries.

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Gastrointestinal stromal tumour (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Common presentations of GIST include early satiety, indigestion, bloating, vague abdominal pain, and gastrointestinal bleeding. Intraperitoneal rupture is an uncommon presentation of GIST. We have encountered two patients prescribed warfarin, who presented with intraperitoneal haemorrhage as their initial presentation of gastric GIST. Computed tomography (CT) revealed a submucosal gastric mass with intralesional and intraperitoneal haemorrhage. The diagnosis of ruptured GIST was made based on CT findings. These two cases are, to the best of our knowledge, the first two cases with rupture and intraperitoneal haemorrhage as the initial presentation of gastric GIST while on warfarin.