Sigmoid stricture, colonic duodenal fistula
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CB1434-Sigmoid stricture, colonic duodenal fistula
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CB1434-Sigmoid stricture, colonic duodenal fistula
Case ReportHistory
Exam
Prior Study
Findings
Findings
A single Scout fluoroscopy grab demonstrates an enteric tube with its tip in the stomach.
There is a 8 fr rectal catheter which has been placed. There is a small volume of bowel gas. The lung bases demonstrate increased markings from bronchopulmonary dysplasia.
A small bore catheter was placed into the rectum and taped. Fluoroscopic spot films were were obtained with the patient in the left lateral, left anterior oblique, and supine positions.
Cysto-Conray was then administered while the patient was in the left lateral position. The rectum and distal portion of the sigmoid colon does demonstrate a small area of underdistention; however, proximal to that the colon demonstrates a more uniform caliber. There is no abnormal mucosal changes.
In the area of the descending colon the contrast moves through an abnormal anatomic connection and passes to the area of the C-loop in the duodenum. This bolus of contrast quickly moved retrograde into the stomach. This bolus was quickly removed via a previously placed NG tube which was on suction.
More contrast was then administered through the rectal tube and again confirmed the presence of this fistula. A fluoroscopic grab showed contrast in the NG tube drainage container.
A total of 290 mL of Cysto-Conray was used during the study.
Total fluoroscopy time was 1.2 min.
Impression
Partial stricture at the level of the sigmoid colon.
This case was discussed with pediatric surgery immediately upon completion.
