Sacral interstim, wireless Bravo pH probe and Sitz markers

Case contributed by Jayanth Keshavamurthy
Diagnosis certain

Presentation

Abdominal radiograph ordered for Sitz markers.

Patient Data

Age: 70 years
Gender: Female

Can you name all the ...

x-ray

Can you name all the hardware? Is this a call report?

Supine radiograph of the abdomen demonstrates a nonobstructive bowel gas pattern with gas and a moderate stool burden demonstrated throughout the colon.

Radiodense circular Sitz markers are identified  throughout the small bowel and colon in the following distribution: 3 within the small bowel, 3 at the splenic flexure, 3 within the left
colon, and 11 within the sigmoid colon.

Cholecystectomy clips are demonstrated in the right upper quadrant.

A sacral InterStim unit is overlying the right iliac crest, with lead traversing the left S1 foramen and lead tip projecting lateral to S2.

Incidentally demonstrated within the small bowel is a Bravo single-channel pH sensor; patient had undergone a pH monitoring study 3 days ago.

Mild degenerative changes of the sacrum are present.

IMPRESSION:
Non-obstructive bowel gas pattern with Sitz markers in small bowel and colon as described above.

Case Discussion

Sacral interstim is seen usual indication is urinary or fecal incontinence.

Wireless pH Bravo probe which is defecated normally.

Sitz markers are seen. Abnormal study.

Cholecystectomy.

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