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Postsurgical and Traumatic Lesions of the Biliary Tract

The two most common surgical procedures of the biliary tract likely to be encountered in day-to-day practice are laparoscopic cholecystectomy (LC) and biliary-enteric anastomosis. Specifically, given the high prevalence of cholelithiasis or gallstones in the United States, with roughly 20 to 25 million people affected, a large number of patients undergo cholecystectomy each year (~700,000). The revolutionary development and refinement of laparoscopic techniques during the last…

Inflammatory Disorders of the Biliary Tract

Primary Sclerosing Cholangitis EPIDEMIOLOGY AND CLINICAL FINDINGS Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown cause. This disease has a typical onset from 20 to 30 years of age but may begin in childhood; it has a 2:1 male-to-female predilection. PSC is commonly associated with inflammatory bowel disease, particularly ulcerative colitis. In patients with ulcerative colitis, 3% to 7.5% have or will…

Neoplasms of the Gallbladder and Biliary Tract

Biliary tract neoplasms include tumors in the bile ducts and gallbladder. Although they are infrequent, most neoplasms that arise from the gallbladder and bile ducts are malignant, resulting in poor prognosis. Gallbladder carcinoma is the seventh most common malignancy of the gastrointestinal tract and is the most common biliary malignancy; bile duct carcinoma occurs less often. Familiarity with the imaging characteristics of gallbladder and bile duct…

Cholelithiasis, Cholecystitis, Choledocholithiasis, and Hyperplastic Cholecystoses

This chapter reviews the imaging findings of gallbladder and biliary calculi and the role of computed tomography (CT), ultrasound, and magnetic imaging (MRI) in the assessment of these disorders. The chapter concludes with a discussion of the spectrum of noninflammatory gallbladder conditions referred to as the hyperplastic cholecystoses. Cholelithiasis Abdominal Radiography Only about 15% to 20% of gallstones are sufficiently calcified enough to be visualized on…

Magnetic Resonance Cholangiopancreatography

Since the first clinical application of magnetic resonance cholangiopancreatography (MRCP) in the early 1990s, MRCP has evolved from a technique with questionable potential for imaging of the biliary tract and pancreatic duct to one that is now recognized as a pivotal tool for the diagnosis of pancreaticobiliary disease. In fact, the evolution of MRCP has been such that at many centers, MRCP has replaced diagnostic endoscopic…

Postoperative Colon

Imaging studies such as water-soluble contrast enemas and computed tomography (CT) are often performed on the postoperative colon to exclude complications such as anastomotic leaks, strictures, fistulas, and abscesses. This chapter discusses the postoperative anatomy and major complications that occur after various forms of colonic surgery. Segmental Resection Segmental resection entails surgical removal of the diseased colonic segment, restoring bowel continuity with an end-to-end, end-to-side, or…

Miscellaneous Abnormalities of the Colon

Colonic Obstruction Mechanical large bowel obstruction is four to five times less common than small bowel obstruction and differs significantly in terms of cause ( Table 46.1 ), pathophysiology, therapy, and prognosis. Colon obstruction is most often the result of a neoplasm ( Table 46.2 ), whereas most small bowel obstructions are caused by adhesions. , A number of extracolonic disease processes, including gynecologic diseases, can…

Polyposis Syndromes

The polyposis syndromes are rare conditions characterized by gastrointestinal (GI) polyposis resulting from specific genetic mutations. A thorough knowledge of the clinical and radiographic manifestations of these syndromes and their complications is required to provide optimal care for affected individuals and their families. Familial Adenomatous Polyposis Syndrome Familial adenomatous polyposis syndrome (FAPS) is a group of related disorders caused by a mutation of the adenomatous polyposis…

Other Tumors of the Colon

This chapter discusses a variety of benign and malignant tumors of the colon as separate entities. Although these tumors are associated with a wide range of clinical and radiologic manifestations, they may have typical features on imaging studies that suggest the correct diagnosis. Lymphoma PATHOLOGIC FINDINGS Malignant lymphomas involve the gastrointestinal (GI) tract as primary neoplasms or as part of a disseminated disease. The colon is…

Polyps and Colon Cancer

Epidemiology Colon cancer is a major public health problem in the United States. As a cause of cancer mortality, it ranks third to prostate and lung cancer in men and breast and lung cancer in women. The American Cancer Society estimates that in the year 2019 about 145,600 persons will be diagnosed with colorectal cancer and that about 67,100 will die of the disease. The distribution…

Other Inflammatory Conditions of the Colon

Infectious and inflammatory disorders of the colon are common and do not require imaging in most cases. In some disorders, imaging has a role in establishing the diagnosis, assessing the severity of the process, monitoring the course of the disease, and determining the presence of complications. Bacterial Infections Infectious colitis may be caused by bacterial, viral, fungal, and parasitic organisms. In Western countries, bacterial colitis represents…

Ulcerative and Granulomatous Colitis: Idiopathic Inflammatory Bowel Disease

The term inflammatory bowel disease (IBD) encompasses two forms of chronic, idiopathic intestinal inflammation, ulcerative colitis and Crohn’s disease. Although many other inflammatory diseases affect the gut, most are distinguished by a specific identifiable causative agent or process or by the nature of the inflammatory activity. The cause of ulcerative colitis and Crohn’s disease is unknown, so these disorders are empirically defined by their typical pathologic,…

Diseases of the Appendix

The vermiform appendix is the smallest segment of the gastrointestinal (GI) tract and the least relevant to its function, yet diseases of the appendix are among the most common surgical emergencies in the Western world. Anatomy The appendix arises anywhere along the medial-posterior wall of the cecum between the ileocecal valve and the cecal tip ( Figs. 40.1 and 40.2 ). A fully developed appendix varies…

Diverticular Disease of the Colon

Colonic diverticula are acquired herniations of the mucosa and of portions of the submucosa through the muscularis propria. Diverticular disease of the colon represents a continuum from an initial, prediverticular phase of marked muscular thickening of the colon wall (myochosis) to frank outpouchings (diverticulosis) and finally to diverticular perforation (diverticulitis). Disease progression from the initial phase to the advanced phases does not necessarily occur. In this…

Computed Tomography Colonography and Evaluation of the Colon

Computed tomography colonography (CTC) is a low-dose, cross-sectional imaging examination optimized for the detection of colorectal polyps and masses. As a result of advanced computer three-dimensional (3D) post-processing, a popular misperception is one of an imaging analogue to optical colonoscopy in which a 3D model alone is used to view the mucosal surface of the colon. However, CTC is fundamentally a different examination, using both 2D…

Functional Imaging of Anorectal and Pelvic Floor Dysfunction

Pelvic floor disorders are an underdiagnosed source of morbidity and significantly diminish the quality of life. Most patients are women. In any clinic that deals with pelvic floor disorders, about 80% of patients will be women between the ages of 35 and 50 years. Pelvic floor disorders are seen less frequently in men. The demand for pelvic floor imaging is increasing. There are several factors that…

Barium Studies of the Colon

Barium enemas are not commonly performed in modern radiology practice because of greater use of other diagnostic tests such as colonoscopy, computed tomography (CT), and, most recently, CT colonography. As senior radiologists retire, it has become increasingly difficult for young radiologists to acquire the expertise needed to capably perform and interpret these studies. Nevertheless, barium enemas can still be useful for evaluating patients with a variety…

Miscellaneous Abnormalitiesof the Small Bowel

Abnormalities of Small Bowel Development in Adults MECKEL’S DIVERTICULUM During embryologic development, the yolk sac is connected to the midgut by the omphalomesenteric duct, which is later obliterated during the seventh to eighth weeks of embryogenesis. Persistence of the entire omphalomesenteric duct results in an enteroumbilical fistula; persistence of part of the duct results in an omphalomesenteric cyst; persistence of the duct as a fibrous cord…

Postoperative Small Bowel

Surgical treatment of small bowel disease requires the use of relatively few surgical techniques, and most are applicable to any segment of the jejunum and ileum. These techniques include enterotomy for removal of polyps or foreign bodies; enteroplasty for treatment of strictures; enterectomy for resection of obstructed, traumatized, neoplastic, or necrotic small bowel; plication to prevent intestinal obstruction, and creation of ostomies or mucous fistulas for…

Vascular Disorders of the Small Intestine

Small bowel abnormalities continue to be a significant diagnostic challenge for clinicians and radiologists. Clinicians have historically struggled to diagnose many small bowel diseases because patients typically present with only nonspecific complaints such as abdominal pain, weight loss, or anemia. Therefore, in most cases, the diagnosis of small bowel pathology is highly dependent on the radiologist. Although fluoroscopic barium studies have traditionally been the mainstay in…