Introduction: Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). This study aimed to analyze the accuracy of ultrasound (US) in diagnosing and staging SBO. Objectives: The main object of this study was to analyze the accuracy of ultrasound in diagnosing and staging SBO compared to CT. Methods: Retrospectively, stable patients with an ultrasonographic diagnosis of SBO who underwent abdominal CT immediately after US and before receiving naso-intestinal decompression, were included. US criteria for the diagnosis of SBO were related to morphological and functional findings. US diagnosis of obstruction was made if fluid-filled dilated small bowel loops were detected, peristalsis was abnormal and parietal abnormalities were present. Morphologic and functional sonographic findings were assigned to three categories: simple SBO, compensated SBO and decompensated SBO. US findings were compared with the results of CT examinations: Morphologic CT findings (divided into loop, vascular, mesenteric and peritoneal signs) allowed the classification of SBO in simple, decompensated and complicated. Results: US diagnostic accuracy rates in relation to CT results were calculated: ultrasound compared to CT imaging, had a sensitivity of 92.31% (95% CI, 74.87% to 99.05%) and a specificity of 94.12% (95% CI, 71.31% to 99.85%) in the diagnosis of SBO. Conclusions: This study, similarly to the existing literature, suggests that ultrasound is highly accurate in the diagnosis of SBO, and that the most valuable sonographic signs are the presence of dilated bowel loops ad abnormal peristalsis.

Ultrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). Because the indications for and timing of surgical intervention for SBO have changed over the past several decades, there is a widespread assumption that the majority of patients with simple SBO may be conservatively managed; in this scenario, staging SBO is crucial. This study evaluated the association between morphological and functional US signs in the diagnosis and staging (simple, decompensated and complicated), and the associations and prevalence of US signs correlated with clinical or surgical outcome. The US signs were divided into diagnostic (dilated bowel loops and altered kinesis) and staging criteria (extraluminal free fluid, parietal and villi alterations). We performed a retrospective, single-center cohort, observational study examining the prevalence of morphologic and functional US signs in the staging of simple, decompensated and complicated SBO. The most significant US signs were dilated bowel loops (100%), hypokinesis (90.46%), thickened walls (82.54%) and free fluid (74.60%). By linear regression, free fluid was positively correlated to US staging in both univariate and multivariate analysis; that is, the more advanced the stage of SBO, the more probable the presence of free fluid between the bowel loops. In univariate analysis only, we found a positive correlation between US staging/thickened walls and the prominence of valvulae conniventes. Additionally, the multivariate analysis indicated that parietal stratification and bowel jump kinesis were negative predictors for US staging in comparison to other US signs. In addition, we found significant associations between conservative treatment or surgery and hypokinesis (p = 0.0326), akinesis (p = 0.0326), free fluid (p = 0.0013) and prominence of valvulae conniventes (p = 0.011). Free fluid in particular was significantly less present in patients that were conservatively treated (p = 0.040). We conclude that the US staging of SBO may be crucial, with a valuable role in the initial diagnosis and staging of the pathology, saving time and reducing total radiation exposure to the patient.

Laparoscopic spleen-preserving distal pancreatectomy is safe and feasible for the management of benign insulinomas. Definition of the tumor with preoperative imaging and laparoscopic ultrasound is essential to achieve high cure rate with minimal conversion.

Purpose Typhlitis, also known as neutropenic colitis, is a rare inflammatory condition and a potentially life-threatening disease process that typically involves the cecum. Delay in diagnosis may lead to a fatal prognosis with a death rate of 21-48%. Ultrasound evaluation of right lower quadrant may lead to an accurate and rapid diagnosis. Methods We describe the case of a 59-year-old female with advanced Churg-Strauss syndrome treated with cyclophosphamide, with acute right lower quadrant pain. Results Ultrasound was the first diagnostic step in the diagnosis of typhlitis. Sonographic findings were comparable to CT imaging. Conclusions Bowel bedside ultrasound evaluation in emergency settings may lead to a prompt and definitive diagnosis. Although CT is considered the gold standard in the diagnosis and staging of neutropenic colitis, ultrasound was able to identify the pathology accurately. Ultrasound findings of typhlitis are highly characteristic, showing circumferential wall thickening with predominant submucosa. Keywords Bedside ultrasound • Typhlitis • Bedside • Acute colitis • Emergency ultrasound SOMMARIO La tiflite, nota anche come colite neutropenica, è una rara forma di colite infiammatoria potenzialmente mortale (21-48%) che coinvolge il cieco, correlata ad alta mortalità se diagnosticata tardivamente. La tipica sintomatologia e localizzazione a livello cecale, rendono la valutazione ecografica e la conoscenza della patologia fondamentale, consentendo una diagnosi differenziale rapida ed efficace. Descriviamo il caso di una donna di 59 anni affetta da sindrome di Churg Strauss, in trattamento con ciclofosfamide che presentava dolore addominale localizzato al quadrante inferiore destro. L'ecografia della fossa iliaca destra ha dimostrato un quadro caratteristico e sovrapponibile ai reperti TC, con presenza di ispessimento e stratificazione parietale del ceco e dell'ultima ansa con prevalenza della sottomucosa. L'esame ecografico dell'intestino in emergenza è in grado di diagnosticare rapidamente ed efficacemente molte patologie intestinali acute, consentendo di differenziare tra patologie chirurgiche non chirurgiche. Nel caso della colite neutropenica, anche se La TC è ancora considerata il gold standard diagnostico, l'esame ecografico può identificare correttamente il quadro patologico ed essere una valido strumento diagnostico per il monitoraggio. I segni ecografici di tifilite sono estremamente caratteristici mostrando un incremento di spessore di parete circonferenziale con prevalenza ed iperecogenicità della sottomucosa.

HighlightsWe report on the application of Irreversible electroporation (IRE) on locally advanced pancreatic cancer (LAPC).We report on a minimally invasive surgical approach supported by laparoscopic ultrasound.We report on a novel technique the benefits of IRE with the advantages of laparoscopic surgery.In medical literature is in our knowledge the first experience.