Pancreatic fluid collections: What is the ideal imaging technique?

Pancreatic fluid collections(PFCs) are seen in up to 50% of cases of acute pancreatitis. The Revised Atlanta classification categorized these collections on the basis of duration of disease and contents, whether liquid alone or a mixture of fluid and necrotic debris. Management of these different types of collections differs because of the variable quantity of debris; while patients with pseudocysts can be drained by straight-forward stent placement, walledoff necrosis requires multi-disciplinary approach. Differentiating these collections on the basis of clinical severity alone is not reliable, so imaging is primarily performed. Contrast-enhanced computed tomography is the commonly used modality for the diagnosis and assessment of proportion of solid contents in PFCs; however with certain limitations such as use of iodinated contrast material especially in renal failure patients and radiation exposure. Magnetic resonance imaging(MRI) performs better than computed tomography(CT) in characterization of pancreatic/peripancreatic fluid collections especially for quantification of solid debris and fat necrosis(seen as fat density globules), and is an alternative in those situations where CT is contraindicated. Also magnetic resonance cholangiopancreatography is highly sensitive for detecting pancreatic duct disruption and choledocholithiasis. Endoscopic ultrasound is an evolving technique with higher reproducibility for fluid-to-debris component estimation with the added advantage of being a single stage procedure for both diagnosis(solid debris delineation) and management(drainage of collection) in the same sitting. Recently role of diffusion weighted MRI and positron emission tomography/CT with ^(18)F-FDG labeled autologous leukocytes is also emerging for detection of infection noninvasively. Comparative studies between these imaging modalities are still limited. However we look forward to a time when this gap in literature will be fulfilled.

Vanek's tumor of the small bowel in adults

Inflammatory fibroid polyps(IFPs), or Vanek's tumor, are one of the least common benign small bowel tumors.IFP affects both sexes and all age groups, with a peak of incidence in the fifth and seventh decades.They can be found throughout the gastrointestinal tract but most commonly in the gastric antrum or ileum.The underlying cause of IFPs is still unknown.Genetic study of IFP showed mutations in platelet derived growth factor alpha in some cases.At the time of diagnosis most IFPs have a diameter of 3 to 4 cm.The lesions have always been recorded as solitary polyps.Symptoms depend on the location and the size of the lesion, including abdominal pain, vomiting, altered small bowel movements, gastrointestinal bleeding and loss of weight.IFPs arising below the Treitz ligament can present with an acute abdomen, usually due to intussusceptions.Abdominal computed tomography is currently considered the most sensitive radiological method to show the polyp or to confirm intussusceptions.Most inflammatory fibroid polyps can be removed by endoscopy.Surgery is rarely needed.Exploratory laparoscopy or laparotomy is frequently recommended as the best treatment for intussusceptions caused by IFP.The operation should be performed as early as possible in order to prevent the intussusceptions from leading to ischemia, necrosis and subsequent perforation of the invaginated bowel segment.This report aims at reviewing the diagnosis, etiology, genetics, clinical presentation, endoscopy, radiology, and best treatment of IFP.