Colorectal DiseaseVolume 25, Issue 10 p. 2119-2120 VIDEO CORRESPONDENCE Laparoscopic complete mesocolic excision and D3 lymphadenectomy for right-sided colon cancer: the use of CT colonography angiography for intraoperative vascular monitoring – a video vignette Antoine Cazelles, Antoine Cazelles orcid.org/0000-0002-9564-0339 Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Conceptualization, Validation, Visualization, Writing - original draftSearch for more papers by this authorFrederik Lecot, Frederik Lecot orcid.org/0000-0002-9149-694X Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Conceptualization, Writing - original draft, Software, Validation, VisualizationSearch for more papers by this authorMehdi Cadi, Mehdi Cadi orcid.org/0000-0002-6276-4861 Medical Imaging Department, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Conceptualization, ​Investigation, Methodology, Validation, SupervisionSearch for more papers by this authorCamélia Labiad, Camélia Labiad orcid.org/0000-0003-0435-4239 Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Validation, Formal analysis, VisualizationSearch for more papers by this authorMehdi Karoui, Mehdi Karoui orcid.org/0000-0003-2644-7321 Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Conceptualization, Validation, Visualization, MethodologySearch for more papers by this authorGilles Manceau, Corresponding Author Gilles Manceau [email protected] orcid.org/0000-0002-0783-8688 Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Correspondence Gilles Manceau, Paris University, Assistance Publique-Hôpitaux de Paris, Department of Digestive and Oncological Surgery, Georges Pompidou University Hospital, Paris, France. Email: [email protected] Contribution: Writing - original draft, Validation, Methodology, Conceptualization, ​Investigation, Visualization, Formal analysis, Supervision, SoftwareSearch for more papers by this author Antoine Cazelles, Antoine Cazelles orcid.org/0000-0002-9564-0339 Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Conceptualization, Validation, Visualization, Writing - original draftSearch for more papers by this authorFrederik Lecot, Frederik Lecot orcid.org/0000-0002-9149-694X Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Conceptualization, Writing - original draft, Software, Validation, VisualizationSearch for more papers by this authorMehdi Cadi, Mehdi Cadi orcid.org/0000-0002-6276-4861 Medical Imaging Department, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Conceptualization, ​Investigation, Methodology, Validation, SupervisionSearch for more papers by this authorCamélia Labiad, Camélia Labiad orcid.org/0000-0003-0435-4239 Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Validation, Formal analysis, VisualizationSearch for more papers by this authorMehdi Karoui, Mehdi Karoui orcid.org/0000-0003-2644-7321 Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Contribution: Conceptualization, Validation, Visualization, MethodologySearch for more papers by this authorGilles Manceau, Corresponding Author Gilles Manceau [email protected] orcid.org/0000-0002-0783-8688 Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Université Paris Cité, Paris, France Correspondence Gilles Manceau, Paris University, Assistance Publique-Hôpitaux de Paris, Department of Digestive and Oncological Surgery, Georges Pompidou University Hospital, Paris, France. Email: [email protected] Contribution: Writing - original draft, Validation, Methodology, Conceptualization, ​Investigation, Visualization, Formal analysis, Supervision, SoftwareSearch for more papers by this author First published: 10 September 2023 https://doi.org/10.1111/codi.16729Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. 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OBJECTIVES:To assess the cost-effectiveness of three colorectal-cancer (CRC) screening strategies in France: fecal-occult-blood tests (FOBT), computed-tomography-colonography (CTC) and optical-colonoscopy (OC). METHODS:Ten-year simulation modeling was used to assess a virtual asymptomatic, average-risk population 50-74 years old. Negative OC was repeated 10 years later, and OC positive for advanced or non-advanced adenoma 3 or 5 years later, respectively. FOBT was repeated biennially. Negative CTC was repeated 5 years later. Positive CTC and FOBT led to triennial OC. Total cost and CRC rate after 10 years for each screening strategy and 0-100% adherence rates with 10% increments were computed. Transition probabilities were programmed using distribution ranges to account for uncertainty parameters. Direct medical costs were estimated using the French national health insurance prices. Probabilistic sensitivity analyses used 5000 Monte Carlo simulations generating model outcomes and standard deviations. RESULTS:For a given adherence rate, CTC screening was always the most effective but not the most cost-effective. FOBT was the least effective but most cost-effective strategy. OC was of intermediate efficacy and the least cost-effective strategy. Without screening, treatment of 123 CRC per 10,000 individuals would cost €3,444,000. For 60% adherence, the respective costs of preventing and treating, respectively 49 and 74 FOBT-detected, 73 and 50 CTC-detected and 63 and 60 OC-detected CRC would be €2,810,000, €6,450,000 and €9,340,000. CONCLUSION:Simulation modeling helped to identify what would be the most effective (CTC) and cost-effective screening (FOBT) strategy in the setting of mass CRC screening in France.

L' ascaridiose des voies biliaires est une complication grave de l'infestation du tractus digestif par Ascaris lumbricoides. Le tableau clinique est peu specifique et le diagnostic rarement evoque dans les pays industrialises ou cette parasitose est peu frequente. Son evocation chez un malade venant d'une zone d'endemie et presentant une pathologie aigue biliaire permet d'eviter les errances diagnostiques et therapeutiques. Nous rapportons un cas d'ascaridiose des voies biliaires pour lequel le diagnostic a ete porte precocement grâce a l'echographie permettant ainsi une prise en charge rapide et adaptee.

This article updates the description of an anatomical variation of the liver, in which the gallbladder is adjacent to the ligamentum teres, that was described until now as "right-sided ligamentum teres and right umbilical portion of the portal vein". A study of eight patients showing this anatomical variation has led to a new archetypal anatomical description of the hepatic and portal veins, using multidetector-row computed tomography (MDCT) with three-dimensional (3D) volume-rendering (VR) reconstructions. While 2D axial imaging gave the same information, MDCT imaging with VR reconstructions provided a clear 3D visualization of this anatomical variation. Typical features can be described as follows: (1) juxtaposition of the ligamentum teres and the gallbladder; (2) typical portal vein branching with a right posterior branch, a left posterior branch and a main medial branch that terminates in the ligamentum teres; (3) two main hepatic veins and a hypotrophied medial hepatic vein. We think, based on the direct comparison of anatomical findings and knowledge of chronological embryological development, that this abnormality results from the defective development of the central part of the liver and not from the persistence of the right rather than the left umbilical vein. Because of the presence of only one medial plane, containing both the gallbladder and the ligamentum teres, we propose renaming it "fusion of hepatic planes".

We report the first case of small-bowel intussusception caused by a tumour-like Brunner's gland hyperplasia in a 26 year old woman. The patient presented with intense abdominal pain. Abdominal and pelvic contrast enhanced CT-scan suggested small bowel intussusception involving the first jejunal loop. A 15 cm long polypoid mass was found in the jejunumectomy specimen (2nd and 3rd loops). Histological examination revealed Brunner's gland hyperplasia in the jejunal mucosa and submucosa. Considering the jejunal location of the lesion, it must be considered malformative and heterotopic Brunner's gland hyperplasia.

Background Alignment of the gallbladder fossa and the round ligament may be associated with an almost unknown portal vein branching anomaly. Study design Ultrasonographic imaging allowed detection of this anomaly, which we characterized as fusion of the planes of the liver. When appropriate, additional specific radiologic examinations were performed (CT scanner supplemented with a three-dimensional reconstruction, a biliary cartography, or an angiography). Surgical consequences were studied from this series and from the literature. Results Seven patients (0.5%) had the following criteria: 1) round ligament, gallbladder fossa, and termination of the portal vein occurring in the same plane; 2) typical portal vein branching, including a right posterior branch, left branches, and a main medial branch terminated by the Rex’s recessus; 3) two main hepatic veins without a significant middle hepatic vein; and 4) absence of the horizontal part of the left hepatic duct. Fusion of the planes may have been involved in two cases of iatrogenic bile duct injury and contraindicated a tumor resection and a right-liver donation. A review of the literature revealed that lack of recognition of the fusion of the planes led to a high proportion of surgical iatrogenic injury. Fusion of the planes could result from incomplete development of the central part of the liver, in agreement with embryologic knowledge. Conclusions Knowledge of the fusion of the planes by hepato-biliary surgeons is important. This anomaly may lead to serious complications if it remains undetected during liver resection or bile duct surgery.

We report the first case of small-bowel intussusception caused by a tumour-like Brunner's gland hyperplasia in a 26 year old woman. The patient presented with intense abdominal pain. Abdominal and pelvic contrast enhanced CT-scan suggested small bowel intussusception involving the first jejunal loop. A 15 cm long polypoid mass was found in the jejunumectomy specimen (2nd and 3rd loops). Histological examination revealed Brunner's gland hyperplasia in the jejunal mucosa and submucosa. Considering the jejunal location of the lesion, it must be considered malformative and heterotopic Brunner's gland hyperplasia.

The purpose of our study was to evaluate the ability of superparamagnetic iron oxide (SPIO)-enhanced MR imaging to detect liver fibrosis in patients with chronic liver disease and to compare the findings with histopathological data. Sixty-seven patients with chronic hepatitis (n=58) or focal nodular hyperplasia (FNH; n=9) were studied using a 1.5-T MR system. The protocol included proton density-weighted, T2-weighted spin-echo (SE) and fast SE (FSE) sequences before and after SPIO administration and T2*-weighted gradient-recalled-echo (GRE) sequences after SPIO. Pre- and post-contrast T2-weighted and T2*-weighted sequences were retrospectively evaluated by three independent observers for evidence of non-tumor hypersignal intensities. Three liver patterns were considered: thick reticulations; thin reticulations; and/or multiple areas of hypersignal intensities. Unenhanced or enhanced patterns were compared with histopathological specimens, which had been obtained by percutaneous biopsy of the right lobe within a maximum of 12 months of MR examination. Liver fibrosis was histologically graded using a five-level scale (F0–F4), according to the METAVIR classification. Histopathology demonstrated significant fibrosis (F2–F4) in 57 patients, non-significant fibrosis in 1 patient (F1), and normal liver surrounding FNH in 9 patients (F0). After SPIO administration, at least one pattern of non-tumor hypersignal intensities was seen in 43 (76%) of the 57 patients with F≥2 with good agreement (kappa=0.68) compared with 2 (20%) of the 10 F0/1 patients (p<0.01). Attenuated non-homogeneous liver-signal intensities with persistent thick reticulations, thin reticulations, or multiple areas of hypersignals were observed in, respectively, 30, 52, and 56% of patients with F≥2 with moderate agreement (kappa=0.51). Before SPIO, MR images were positive in 21 of 57 (37%) F≥2 and zero F0/1 patients. Post-contrast proton-density-weighted and T2*-weighted GRE were the most sensitive sequences for detecting non-tumor hypersignal intensities. In patients with chronic liver diseases, SPIO-enhanced MR imaging exhibits non-tumor hypersignal intensities indicative of liver fibrosis by decreasing the signal from the non-fibrotic areas where Kupffer cells are present.

To compare findings of active pulmonary tuberculosis on computed tomography (CT) and high-resolution computed tomography (HRCT) scans in patients without the human immunodeficiency virus (HIV) and patients with HIV, and to define the spectrum of pulmonary tuberculosis in patients with HIV according to the CD4 T cell status, 76 patients (47 patients without HIV and 29 patients with HIV) with newly diagnosed pulmonary tuberculosis were studied retrospectively. The diagnosis of active pulmonary tuberculosis was based on acid-fast bacilli (AFB) in sputum culture. All patients underwent CT within 1 month of diagnosis. Patients with HIV demonstrated significantly less cavitation and bronchial wall thickening (24% vs. 49% [p < 0.05]; and 14% vs. 45% [p < 0.01], respectively) than the combined group of patients with HIV. Centrilobular nodules were significantly less common in patients without HIV (14% vs. 45%, p < 0.05). Lymphadenopathy with low attenuation centers was significantly less frequent in the patients with HIV (3% vs. 15%, p < 0.05). In patients with HIV, cavitation, lymphadenopathy, as well as the the number of nodules and the number of lobes involved correlated well with the CD4 levels. Two patients with less than 50 CD4 T cells/mm3 had normal chest CT results. Atypical chest CT patterns are frequently encountered in patients with HIV. Knowledge of these CT patterns may assist in the diagnosis and follow-up of patients with HIV with known or suspected pulmonary tuberculosis.

Purpose: The aim of this study was to determine discriminating CT and HRCT features between mycobacterial pulmonary tuberculosis and nontuberculous mycobacterial (NTMB) pulmonary infections in patients with AIDS.Method: CT and HRCT scans of 52 AIDS patients with culture-proven mycobacterial infection [29 with Mycobacterium tuberculosis (MTB) and 23 with NTMB] without concomitant pulmonary infection were reviewed by two observers.Results: Nodular opacities, mainly centrilobular in distribution, were the most common finding, seen in 21 (72%) and 15 (65%) of patients with MTB and NTMB, respectively. A lower lobe predominance of centrilobular nodules was seen more commonly in NTMB (p < 0.03). Ground-glass attenuation was seen in 5 (17%) and 11 (48%) of patients with MTB and NTMB, respectively (p = 0.03). Ground-glass opacities and bronchial wall thickening affected a larger number of lobes in NTMB (p < 0.01), while centrilobular nodules involved more lobes in MTB (p < 0.01). A higher prevalence of unilateral lung involvement was seen in MTB (12 patients, 44%) than NTMB (1 patient, 5%) (p < 0.01). Enlarged lymph nodes were more frequent in patients with MTB than in those with NTMB (22, 76% vs. 10, 43%, respectively) (p < 0.02).Conclusion: NTMB infection and pulmonary tuberculosis display different CT and HRCT patterns in AIDS patients, but there is considerable overlap in CT findings.