GI

Question 1

Intusussception

Answer 1

Findings

• Evidence of mass with concentric layering within it – intususseption ( lipoma, polyp)
• bowel-within-bowel configuration
• USS- concentric rings of bowel
• Efferent bowel is dilated
• Afferent bowel is collapsed
• Transition point is in the pelvis
• Free fluid in the abdomen
• No perforation
• No pneumoperitoneum
• No pericardial effusion.
• Liver, spleen, panceas, adrenals and kidneys.
• No lymphadenopathy
• Lung bases
• Bones

Diagnosis

• Ileo-ileal intususseption
• Lead point intra-luminal mass

Differential

1. Malignancy-
   
   1. Primary bowel cancer
   2. Secondary- Met- melanoma, breast, lung
   3. Lymphoma
2. Benign
   
   1. Poylp
   2. Lipoma
3. Congenital
   
   1. Meckel
   2. Duplication cyst
   3. Ectopic pancreas

Management

• Surgical review
• Paeds- 3 attempts lasting 3 minutes, 100mm HG

Question 2

Sidebranch IPMN

Answer 2

Findings

• Cystic lesions arising of the main pancreatic duct perpendicular to the long axis, communicate with the main pancreatic duct
• Normal pancreatic duct size
• Dilated Extrahepatic bile duct
• Normal CBD
• Dilated intra-hepatic biliary tree, scattered calcifications within the intrahepatic ducts
• Extensive choledocholithiasis.
• No solid pancreatic mass
• Normal adrenals, kidneys and liver

Diagnosis

• Side branch IPMN
• Choledocholithiasis

Differential

Management

• Referral to surgeon
• EUS/ERCP

Question 3

Annular pancreas

Answer 3

• There is a soft tissue abnormality encasing the duodenum.
• It is continuous with the pancreas and of same signal.
• There is a duct continuous with the main pancreatic duct that inserts into the 2^nd part of the duodenum- Santorini inserting into minor papilla.
• There is an inferior pancreatic duct that is continuous with the common bile duct and inserts into the major papilla.
• There is mild stranding around the pancreatic head in keeping with pancreatitis.
• No duodenal obstruction.
• • No intra-hepatic biliary abnormality- filling defect or stricture.
• No gallstones.

Diagnosis

Annular pancreas-

Evidence of mild pancreatitis.

No gastric outlet obstruction.

Management

Surgical review