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Diagnostic Clues to Colon Cancer with Screening Ultrasound
S88
Ultrasound in Medicine and Biology
Conclusion: Ultrasonography may provide an accurate modality of evaluating gallbladder disease. Appropriate technique, strict diagnostic criteria, and knowledge of pitfalls are necessary to avoid false diagnosis and potential patient hazard. If there is a diagnostic uncertainty, we should not hesitate to use other diagnostic modalities.
Volume 37, Number 8S, 2011 CT scan confirmed it later. Surgery identified a small tumor in the bowel wall as the cause of intussusception. Conclusion: It was a gastrointestinal stromal tumor (GIST) with low mitotic index. P 046 ee
P 043 se Differential Diagnosis of Gallbladder Polypoid Lesions Assessed with Contrast-Enhanced Ultrasonography M. Hattori,1 M. Katayama,1 M. Tomita,1 M. Yamazaki,2 K. Hara,2 S. Ito,2 H. Hara,2 K. Inui3 1 Gastoroenterology, Yamashita Hospital, Ichinomiya/JP, 2Radiology, Yamashita Hospital, Ichinomiya/JP, 3Internal Medicine, Fujita Health University Second Teaching Hospital, Nagoya/JP Purpose: To investigate the efficacy of differential diagnosis of gallbladder polypoid lesions assessed with contrast-enhanced ultrasonography using perflubutane (SonazoidÒ) (Daiichi-Sankyo, Tokyo). Material & Methods: We treated 76 patients with gallbladder polypoid lesions, including 16 adenocarcinoma, 41 benign polyp, and 19 adenomyomatosis. We used SSA-770A, 790A (Toshiba, Tokyo), or Prosound alpha 10 (ALOKA, Tokyo). The early vascular phase about 30 sec after administration was observed and monitored for approximately 3 min. With the Prosound alpha 10, the region of interest was configured for all the lesions and the histogram of brightness was analyzed. Results: All 16 of the gallbladder cancer lesions showed hypervascular staining and ‘‘eruption sign’’ was apparent. Blood flow imaging revealed irregular size and buckling, including tortuous vessels in 10 cases (62.5%) and erratic blood flow in 8 cases (50%). For gallbladder polyp, staining was scattered within them, and ‘‘flickering sign’’ was observed in 35 cases (85.4%). Blood flow image showed normal vessels without buckling. For adenomyomatosis, staining was scattered and mild flickering signs were observed in all cases. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clarity. High brightness of the region of interest tended to be sustained in the gallbladder cancer group. Conclusion: Contrast-enhanced ultrasonography using SonazoidÒ can clearly detect hemodynamics, and it is effective to verify the differential diagnosis of gallbladder polypoid lesions.
Abdominal / Gastrointestinal Tract (GI) P 044 se Intestinal Intussusception Determined by a Gastrointestinal Stromal Tumor M. Enache, M. Iriciuc, T. Artenie, C. Jurcut, M. Sotcan, A. Dima, F. Vasilescu Internal Medicine, Central Military Hospital, Bucharest/RO Purpose: Intestinal intussusception, defined as telescoping of a segment of intestine in an immediately adjacent portion, is common in children, in whom it is usually primary and benign, and rare in adults, in this population being almost always secondary to other pathological conditions. Material & Methods: We present a case of a 57-year-old patient, who had episodes of abdominal pain, nausea and vomiting for 4 months, often accompanied by constipation. Prior laboratory data, ultrasound and endoscopic data did not find the cause of these symptoms. Results: At admission in our department, abdominal ultrasound identified a diffuse intestinal distension and a paraumbilical target image (concentric rings with increasing and decreasing echogenicity with a bowel wall which slightly changed its shape with the progression of intestinal peristaltic waves), suggesting intestinal intussusception. The
Diagnosis and Evaluation of Therapeutic Effects on Rectal Varices Using Percutaneous Color Doppler Ultrasonography T. Sato, K. Yamazaki, J. Akaike Gastroenterology, Sapporo Kosei General Hospital, Sapporo/JP Learning Objectives: Rectal varices are an infrequent but potentially serious cause of hematochezia. Here, we report the usefulness of percutaneous color Doppler ultrasonography (CD) in diagnosing and evaluating the therapeutic effects of rectal varices. Background: Ultrasonographic examinations were performed using a color Doppler unit with a 3.5-MHz convex probe. The rectum was observed through the bladder filled with urine by sonography. We examined color flow images and measured the velocity of blood flow in rectal varices using fast-Fourier transform analysis by CD in all 30 patients, before and after treatments. Imaging Findings or Procedure Details: Rectal varices were detected by CD in all 30 patients before treatments. Blood flow velocity in the rectal varices ranged from 5.7 to 36.6 cm/s (mean 11.6 cm/s). Rectal varices were observed in all patients by colonoscopy: enlarged tortuous varices with red color sign in 23, coil-shaped varices in 5, and enlarged tortuous varices without red color in 2. Seven days after treatment, CD showed an extreme decrease in blood flow in all 30 rectal varices, compared to values before treatments. Blood flow velocities in the residual rectal varices were in the range of 0.0-9.6 cm/s (mean 4.0 cm/s) after treatment, with the mean velocity significantly lower in cases after treatment (p , 0.001). Conclusion: CD can be considered a useful tool for diagnosis of rectal varices and is useful for evaluating the therapeutic effects of treatments for rectal varices.
P 047 se Diagnostic Clues to Colon Cancer with Screening Ultrasound M. Tomizawa,1 F. Shinozaki,2 R. Hasegawa,3 Y. Shirai,3 N. Ichiki,3 T. Sugiyama,4 S. Yamamoto,5 M. Sueishi,4 T. Yoshida6 1 Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 2Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 3Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 4Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 5Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 6Department of Internal Medicine, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP Purpose: Diagnosis of colon cancer with ultrasound is simple with information that a patient has the disease. Conversely, the diagnosis is challenging with screening ultrasound. To establish clues to diagnose colon cancer with screening abdominal ultrasound, we analyzed patient’s characteristics. Material & Methods: Since November 2009 to October 2010, 4 patients showed wall thickness or tumor of the colon with screening ultrasound suggesting colon cancer. Colonoscopy (CF) revealed colon cancers of 2 patients while normal findings of 2 patients. Characteristics of these patients were analyzed. Results: Patient 1 had irregular shaped 3x2 cm low echo lesion in ascending colon with the diameter of 2.0 cm, 10600 /ml of white blood cell (WBC), 2.8 mg/ml of C-reactive protein (CRP), and 9.7 ng/ml of CEA. Patients 2 had a 5x2.5 cm tumor in sigmoid colon, 7500 of
Abstracts WBC, 13.2 of CRP, and 11.7 of CEA. CF revealed cancer of patient 1 and 2. Patient 3 showed irregular shaped 3.1x2.2 cm low echo lesion in ascending colon, and patient 4 showed thickened wall of ascending colon, but both lesions became unclear one week later. WBC was 4000, CRP 0.3, CEA 2.1, respectively, in patient 3. WBC was 6100, CRP 0.1, CEA 7.6, respectively, in patient 4. Conclusion: Reproducibility of tumor, leukocytosis, elevated CRP and CEA were the clues to diagnose colon cancer with screening ultrasound. P 048 se Endosonographic Tumor Staging for Treatment Decision in Resectable Gastric Cancer W. Bohle, A. Scheidig, W. G. Zoller Klinik f€ ur Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und Infektiologie, KatharinenHospital, Klinikum Stuttgart, Stuttgart/DE Purpose: Neoadjuvant preoperative chemotherapy is the standard of care in locally advanced resectable gastric cancer. Therefore, exact locoregional staging is essential for treatment decision. EUS is believed to be the most potent diagnostic method for locoregional staging. However, it is questionable, if results from centers of excellence can be maintained in clinical routine. Material & Methods: We retrospectively analyzed the data of 62 resectable gastric cancers staged by EUS during routine clinical workup. Preoperative variables (tumor size and site, histological differentiation) were compared with the postoperative pathology. Results: 19 locally limited (T1-2, N0) and 43 locally advanced (T3-4, or N+ irrespective of T stage) were analyzed. The sensitivity of EUS for the detection of locally advanced disease was 93%, with a specificity of 78%. Conclusion: Even in daily routine practice, differentiation of locally limited and advanced disease with EUS can be performed with high sensitivity and good specifity. Therefore, EUS is an essential part of the diagnostic procedure in patients with gastric cancer.
S89
Conclusion: Endoluminal ultrasonography plus perineal ultrasonography can more accurately depict fistulous track and external opening of the anal fistula than endoluminal ultrasonography alone. P 050 se Gastrointestinal Wall Thickness Is Dependent on Weight and Age K. Nylund,1 T. Hausken,1 S. Ødegaard,2 O. H. Gilja2 1 Institute of Medicine, University in Bergen, Bergen/NO, 2National Centre for Ultrasound In Gastroenterology, Haukeland University Hospital, Bergen/NO Purpose: To study the influence of demographic factors on gastrointestinal (GI) wall thickness and individual wall layers in the GI wall using transabdominal ultrasound. Material & Methods: The wall thickness in the antrum, jejunum, ileum, colon and rectum and individual wall layers in the ileum and sigmoid colon were examined with transabdominal ultrasound in 122 healthy volunteers of age range 23-79 years. The examination was performed after approximately 8 hours fasting using 8 and 12 MHz linear ultrasound transducers. Gender, age, weight, height and tobacco use of the subjects were recorded. Multiple linear regression applying a mixed model was used for analysis. Results: In the ileum, the mucosa and submucosa were 0.4 6 0.1mm (mean6SD) each and the proper muscle was 0.4 6 02mm. In the sigmoid colon, the corresponding values were 0.3 6 0.1mm and 0.5 6 0.1mm, respectively. There was an overall increase in GI wall thickness with decreasing transducer frequency (p , 0.001) and with increasing weight (p 5 0.046) in the duodenum and sigmoid colon. Increasing age was related to increased thickness of the GI wall in the ileum and sigmoid colon (p , 0.001), and in the same locations, weight (p , 0.001) and age (p 5 0.002) were associated with thickening of all wall layers. Conclusion: Increasing weight is associated with wall thickening in the duodenum and sigmoid colon and increasing age with wall thickening in both the ileum and sigmoid colon. This seems to be due to a general thickening of all wall layers.
P 049 ee Anal Fistula and Perianal Abscess: Usefulness of Endoluminal US Plus Perineal US H. N. Jung,1 D. Choi,1 J. Lee,2 S. J. Lee1 1 Department of Radiology, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul/KR, 2Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul/KR Learning Objectives: To know the findings of endoluminal US plus perineal US in patients with anal fistula or perianal abscess, and to evaluate its usefulness. Background: Most of the anal fistulas are secondary to infection arising from the anal glands. The majority of the glands are subepithelial in position, with a few lying in the longitudinal layer deep to the internal sphincter. If an abscess develops in an infected gland, it is most likely to discharge spontaneously into the anal canal providing the abscess is superficial in the internal sphincter; but if the abscess is deep in the sphincter, and when the abscess ruptures, pus will track along an intersphincteric or transsphincteric route forming a sinus and eventually a fistula. Other inflammatory conditions may lead to anal fistula: hidradenitis, ulcerative colitis, tuberculosis and Crohn’s disease. Imaging Findings or Procedure Details: Endoluminal US is widely used for the diagnosis of anal fistula due to the rapid, simple and well tolerated technique. In addition, it gives information about the fistula track and has an excellent accuracy rate in the preoperative location of an internal opening. Because of field-of-view limitations, however, endoluminal US usually cannot show the entire track of the fistula and the external opening. On the other hand, perineal US gives a more accurate information about the length of the fistula and the external opening.
P 051 se Study of Blood Flow in the Hepatic Artery and Celiac Trunk in Patients with Gastric Ulcers, Complicated by Hemorrhage S. Sayfieva, N. Dadamyants, A. Fazilov Ultrasound Diagnostics, Tashkent Institute of Postgraduate Medical Education, Tashkent/UZ Purpose: The Doppler study of hepatic artery (HA) and celiac trunk (CT) in patients with stomach ulcer is complicated by hemorrhage. Material & Methods: A comprehensive ultrasonographic study of gastric and duodenal ulcer in 25 people without pathology (control group) and 40 patients with gastric ulcer (GU) was conducted. We assessed the state of ulcers: Vmax, m/s, RI. Results: In control group, Vmax in CT was 0.95 + 0.18 m/c, HA 0.62 + 0.07 m/c. RI in CT was 0.65 + 0.04, HA 0.6 + 0.04. In patients with GU, acceleration of blood flow largely to the HA was noted. On average, it amounted to 25-30% of initial values. Flow velocity in the CT and RI changed less significantly. There was a tendency to increase the RI of the HA. Treatment normalized RI ^aV,^aV,and decreased Vmax of the HA. Conclusion: In patients with GU complicated with bleeding, the most pronounced changes in the HA show increased blood flow without changing the index RI. Ultrasound examination can be of great help in cases of inability to perform radiographic and endoscopic examinations. The role of integrated ultrasound is significant for perforated ulcers of the stomach and monitoring during treatment.
Ultrasound in Medicine and Biology
Conclusion: Ultrasonography may provide an accurate modality of evaluating gallbladder disease. Appropriate technique, strict diagnostic criteria, and knowledge of pitfalls are necessary to avoid false diagnosis and potential patient hazard. If there is a diagnostic uncertainty, we should not hesitate to use other diagnostic modalities.
Volume 37, Number 8S, 2011 CT scan confirmed it later. Surgery identified a small tumor in the bowel wall as the cause of intussusception. Conclusion: It was a gastrointestinal stromal tumor (GIST) with low mitotic index. P 046 ee
P 043 se Differential Diagnosis of Gallbladder Polypoid Lesions Assessed with Contrast-Enhanced Ultrasonography M. Hattori,1 M. Katayama,1 M. Tomita,1 M. Yamazaki,2 K. Hara,2 S. Ito,2 H. Hara,2 K. Inui3 1 Gastoroenterology, Yamashita Hospital, Ichinomiya/JP, 2Radiology, Yamashita Hospital, Ichinomiya/JP, 3Internal Medicine, Fujita Health University Second Teaching Hospital, Nagoya/JP Purpose: To investigate the efficacy of differential diagnosis of gallbladder polypoid lesions assessed with contrast-enhanced ultrasonography using perflubutane (SonazoidÒ) (Daiichi-Sankyo, Tokyo). Material & Methods: We treated 76 patients with gallbladder polypoid lesions, including 16 adenocarcinoma, 41 benign polyp, and 19 adenomyomatosis. We used SSA-770A, 790A (Toshiba, Tokyo), or Prosound alpha 10 (ALOKA, Tokyo). The early vascular phase about 30 sec after administration was observed and monitored for approximately 3 min. With the Prosound alpha 10, the region of interest was configured for all the lesions and the histogram of brightness was analyzed. Results: All 16 of the gallbladder cancer lesions showed hypervascular staining and ‘‘eruption sign’’ was apparent. Blood flow imaging revealed irregular size and buckling, including tortuous vessels in 10 cases (62.5%) and erratic blood flow in 8 cases (50%). For gallbladder polyp, staining was scattered within them, and ‘‘flickering sign’’ was observed in 35 cases (85.4%). Blood flow image showed normal vessels without buckling. For adenomyomatosis, staining was scattered and mild flickering signs were observed in all cases. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clarity. High brightness of the region of interest tended to be sustained in the gallbladder cancer group. Conclusion: Contrast-enhanced ultrasonography using SonazoidÒ can clearly detect hemodynamics, and it is effective to verify the differential diagnosis of gallbladder polypoid lesions.
Abdominal / Gastrointestinal Tract (GI) P 044 se Intestinal Intussusception Determined by a Gastrointestinal Stromal Tumor M. Enache, M. Iriciuc, T. Artenie, C. Jurcut, M. Sotcan, A. Dima, F. Vasilescu Internal Medicine, Central Military Hospital, Bucharest/RO Purpose: Intestinal intussusception, defined as telescoping of a segment of intestine in an immediately adjacent portion, is common in children, in whom it is usually primary and benign, and rare in adults, in this population being almost always secondary to other pathological conditions. Material & Methods: We present a case of a 57-year-old patient, who had episodes of abdominal pain, nausea and vomiting for 4 months, often accompanied by constipation. Prior laboratory data, ultrasound and endoscopic data did not find the cause of these symptoms. Results: At admission in our department, abdominal ultrasound identified a diffuse intestinal distension and a paraumbilical target image (concentric rings with increasing and decreasing echogenicity with a bowel wall which slightly changed its shape with the progression of intestinal peristaltic waves), suggesting intestinal intussusception. The
Diagnosis and Evaluation of Therapeutic Effects on Rectal Varices Using Percutaneous Color Doppler Ultrasonography T. Sato, K. Yamazaki, J. Akaike Gastroenterology, Sapporo Kosei General Hospital, Sapporo/JP Learning Objectives: Rectal varices are an infrequent but potentially serious cause of hematochezia. Here, we report the usefulness of percutaneous color Doppler ultrasonography (CD) in diagnosing and evaluating the therapeutic effects of rectal varices. Background: Ultrasonographic examinations were performed using a color Doppler unit with a 3.5-MHz convex probe. The rectum was observed through the bladder filled with urine by sonography. We examined color flow images and measured the velocity of blood flow in rectal varices using fast-Fourier transform analysis by CD in all 30 patients, before and after treatments. Imaging Findings or Procedure Details: Rectal varices were detected by CD in all 30 patients before treatments. Blood flow velocity in the rectal varices ranged from 5.7 to 36.6 cm/s (mean 11.6 cm/s). Rectal varices were observed in all patients by colonoscopy: enlarged tortuous varices with red color sign in 23, coil-shaped varices in 5, and enlarged tortuous varices without red color in 2. Seven days after treatment, CD showed an extreme decrease in blood flow in all 30 rectal varices, compared to values before treatments. Blood flow velocities in the residual rectal varices were in the range of 0.0-9.6 cm/s (mean 4.0 cm/s) after treatment, with the mean velocity significantly lower in cases after treatment (p , 0.001). Conclusion: CD can be considered a useful tool for diagnosis of rectal varices and is useful for evaluating the therapeutic effects of treatments for rectal varices.
P 047 se Diagnostic Clues to Colon Cancer with Screening Ultrasound M. Tomizawa,1 F. Shinozaki,2 R. Hasegawa,3 Y. Shirai,3 N. Ichiki,3 T. Sugiyama,4 S. Yamamoto,5 M. Sueishi,4 T. Yoshida6 1 Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 2Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 3Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 4Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 5Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 6Department of Internal Medicine, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP Purpose: Diagnosis of colon cancer with ultrasound is simple with information that a patient has the disease. Conversely, the diagnosis is challenging with screening ultrasound. To establish clues to diagnose colon cancer with screening abdominal ultrasound, we analyzed patient’s characteristics. Material & Methods: Since November 2009 to October 2010, 4 patients showed wall thickness or tumor of the colon with screening ultrasound suggesting colon cancer. Colonoscopy (CF) revealed colon cancers of 2 patients while normal findings of 2 patients. Characteristics of these patients were analyzed. Results: Patient 1 had irregular shaped 3x2 cm low echo lesion in ascending colon with the diameter of 2.0 cm, 10600 /ml of white blood cell (WBC), 2.8 mg/ml of C-reactive protein (CRP), and 9.7 ng/ml of CEA. Patients 2 had a 5x2.5 cm tumor in sigmoid colon, 7500 of
Abstracts WBC, 13.2 of CRP, and 11.7 of CEA. CF revealed cancer of patient 1 and 2. Patient 3 showed irregular shaped 3.1x2.2 cm low echo lesion in ascending colon, and patient 4 showed thickened wall of ascending colon, but both lesions became unclear one week later. WBC was 4000, CRP 0.3, CEA 2.1, respectively, in patient 3. WBC was 6100, CRP 0.1, CEA 7.6, respectively, in patient 4. Conclusion: Reproducibility of tumor, leukocytosis, elevated CRP and CEA were the clues to diagnose colon cancer with screening ultrasound. P 048 se Endosonographic Tumor Staging for Treatment Decision in Resectable Gastric Cancer W. Bohle, A. Scheidig, W. G. Zoller Klinik f€ ur Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und Infektiologie, KatharinenHospital, Klinikum Stuttgart, Stuttgart/DE Purpose: Neoadjuvant preoperative chemotherapy is the standard of care in locally advanced resectable gastric cancer. Therefore, exact locoregional staging is essential for treatment decision. EUS is believed to be the most potent diagnostic method for locoregional staging. However, it is questionable, if results from centers of excellence can be maintained in clinical routine. Material & Methods: We retrospectively analyzed the data of 62 resectable gastric cancers staged by EUS during routine clinical workup. Preoperative variables (tumor size and site, histological differentiation) were compared with the postoperative pathology. Results: 19 locally limited (T1-2, N0) and 43 locally advanced (T3-4, or N+ irrespective of T stage) were analyzed. The sensitivity of EUS for the detection of locally advanced disease was 93%, with a specificity of 78%. Conclusion: Even in daily routine practice, differentiation of locally limited and advanced disease with EUS can be performed with high sensitivity and good specifity. Therefore, EUS is an essential part of the diagnostic procedure in patients with gastric cancer.
S89
Conclusion: Endoluminal ultrasonography plus perineal ultrasonography can more accurately depict fistulous track and external opening of the anal fistula than endoluminal ultrasonography alone. P 050 se Gastrointestinal Wall Thickness Is Dependent on Weight and Age K. Nylund,1 T. Hausken,1 S. Ødegaard,2 O. H. Gilja2 1 Institute of Medicine, University in Bergen, Bergen/NO, 2National Centre for Ultrasound In Gastroenterology, Haukeland University Hospital, Bergen/NO Purpose: To study the influence of demographic factors on gastrointestinal (GI) wall thickness and individual wall layers in the GI wall using transabdominal ultrasound. Material & Methods: The wall thickness in the antrum, jejunum, ileum, colon and rectum and individual wall layers in the ileum and sigmoid colon were examined with transabdominal ultrasound in 122 healthy volunteers of age range 23-79 years. The examination was performed after approximately 8 hours fasting using 8 and 12 MHz linear ultrasound transducers. Gender, age, weight, height and tobacco use of the subjects were recorded. Multiple linear regression applying a mixed model was used for analysis. Results: In the ileum, the mucosa and submucosa were 0.4 6 0.1mm (mean6SD) each and the proper muscle was 0.4 6 02mm. In the sigmoid colon, the corresponding values were 0.3 6 0.1mm and 0.5 6 0.1mm, respectively. There was an overall increase in GI wall thickness with decreasing transducer frequency (p , 0.001) and with increasing weight (p 5 0.046) in the duodenum and sigmoid colon. Increasing age was related to increased thickness of the GI wall in the ileum and sigmoid colon (p , 0.001), and in the same locations, weight (p , 0.001) and age (p 5 0.002) were associated with thickening of all wall layers. Conclusion: Increasing weight is associated with wall thickening in the duodenum and sigmoid colon and increasing age with wall thickening in both the ileum and sigmoid colon. This seems to be due to a general thickening of all wall layers.
P 049 ee Anal Fistula and Perianal Abscess: Usefulness of Endoluminal US Plus Perineal US H. N. Jung,1 D. Choi,1 J. Lee,2 S. J. Lee1 1 Department of Radiology, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul/KR, 2Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul/KR Learning Objectives: To know the findings of endoluminal US plus perineal US in patients with anal fistula or perianal abscess, and to evaluate its usefulness. Background: Most of the anal fistulas are secondary to infection arising from the anal glands. The majority of the glands are subepithelial in position, with a few lying in the longitudinal layer deep to the internal sphincter. If an abscess develops in an infected gland, it is most likely to discharge spontaneously into the anal canal providing the abscess is superficial in the internal sphincter; but if the abscess is deep in the sphincter, and when the abscess ruptures, pus will track along an intersphincteric or transsphincteric route forming a sinus and eventually a fistula. Other inflammatory conditions may lead to anal fistula: hidradenitis, ulcerative colitis, tuberculosis and Crohn’s disease. Imaging Findings or Procedure Details: Endoluminal US is widely used for the diagnosis of anal fistula due to the rapid, simple and well tolerated technique. In addition, it gives information about the fistula track and has an excellent accuracy rate in the preoperative location of an internal opening. Because of field-of-view limitations, however, endoluminal US usually cannot show the entire track of the fistula and the external opening. On the other hand, perineal US gives a more accurate information about the length of the fistula and the external opening.
P 051 se Study of Blood Flow in the Hepatic Artery and Celiac Trunk in Patients with Gastric Ulcers, Complicated by Hemorrhage S. Sayfieva, N. Dadamyants, A. Fazilov Ultrasound Diagnostics, Tashkent Institute of Postgraduate Medical Education, Tashkent/UZ Purpose: The Doppler study of hepatic artery (HA) and celiac trunk (CT) in patients with stomach ulcer is complicated by hemorrhage. Material & Methods: A comprehensive ultrasonographic study of gastric and duodenal ulcer in 25 people without pathology (control group) and 40 patients with gastric ulcer (GU) was conducted. We assessed the state of ulcers: Vmax, m/s, RI. Results: In control group, Vmax in CT was 0.95 + 0.18 m/c, HA 0.62 + 0.07 m/c. RI in CT was 0.65 + 0.04, HA 0.6 + 0.04. In patients with GU, acceleration of blood flow largely to the HA was noted. On average, it amounted to 25-30% of initial values. Flow velocity in the CT and RI changed less significantly. There was a tendency to increase the RI of the HA. Treatment normalized RI ^aV,^aV,and decreased Vmax of the HA. Conclusion: In patients with GU complicated with bleeding, the most pronounced changes in the HA show increased blood flow without changing the index RI. Ultrasound examination can be of great help in cases of inability to perform radiographic and endoscopic examinations. The role of integrated ultrasound is significant for perforated ulcers of the stomach and monitoring during treatment.