 Today I'm going to present a paper on the topic of role of ultrasoundography and computer tomography in evaluation of bowel pathologies. The aim of the study was role of ultrasoundography and computer tomography in evaluation of bowel pathologies and objectives were to find out the etiologies of the abdominal pain and to find out the infective inflammatory and neoplastic conditions affecting the bowel to find out the sensitivity of USG and CT scan to diagnose the bowel pathology. And the introduction, the pain abdomen is important and common complaint of patients going to medical room and it is seen and 5-10% of all emergency cases. However, majority of the patients have generalized self-lifting symptoms and only few patients have serious intra-abdominal diseases which require intervention. And ultrasound and CT are the most widely used diagnostic imaging modalities in patients attending this emergency department with acute abdominal pain. Both the imaging modalities are commonly used and considered important aspect of clinical and laboratory evaluation. In the last two decades among the cross-sectional imaging techniques, ultrasound had a growing role in development and application of techniques for diagnosis of GI diseases because it is cheap, non-invasive and more comfortable for the patient. And it has sufficient diagnostic accuracy to provide the clinician with high temporal and spatial resolution imaging data. Moreover, Doppler and contrast-enhanced ultrasound contribute important information about the blood flow. And in ultrasound, when there is a presence of gas and other intestinal content, it may make the assessment difficult in some cases. Therefore, this makes the endoscopy magnet MRI imaging and commuted tomography scan as the preferred imaging modalities. Upper GI evaluation with the use of the small bowel follow-through CT scan and MRI entrography are used for diagnosis of small intestine disorders. And CT scan is now considered as the primary imaging modality for inflammatory bowel disease and its complication due to the higher resolution assessment of intestine and extranetal diseases. And it also due to the short acquisition time and full-time availability. And the use of newer, more sophisticated multi-director helical CT scan machines which allow the higher resolution imaging of the abdomen, particularly the bowel loops, which generate images in multiple directions to assist the visualization of not very noticeable abnormalities. And in this study, we compared the ultrasound with CT in detecting the causes of common bowel pathologies such as appendicitis, diabeticalitis, volvulus in patients present in the hospital with acute abdominal pain in majority of the cases. And the methods which we used at the place of study was Dr. Dewey Barton Michael College and Hospital Cooney. And the study design was a processional study which was done for one year with a sample size of 100 cases. And inclusion criteria is as a clinically suspected lesion of the bowel. And the exclusion criteria were the patient allergic to ironated contrast media or pregnant women and patients with chronic renal diseases. And the equipment used was Phil's computer tomography imaging which is round 28 slice CT scan and ultrasound imaging machines like Aloka, Hitachi. And the technique for the CT scan, well, all the patients were called for at least six hours fasting before the scan. And the written consent was obtained from each patient after explaining the possibility of contrast reaction. Oral contrast will be administered 45 minutes prior to the scan. And the non-independent CT scan of the abdomen will be done taking five-month in axial sections of five-month interval from dome of diaphragm up to the level of cubic symphysis. And the patients will be caused to breath holding prior to the scan. And the IV contrast is given as per the weight of the patient. And after administration, the images are acquired in the hotel and menace phases, which is an easily optimized for the evaluation of important visit organs. A cross-sectional study was done on patients presenting with abdominal pain and all the clinically suspected lesions involved in the bowel in the patients were clinically evaluated and they underwent ultrasound and commuter tomography within a few hours of presentation. And the results, whereas we have, we have, we have done a bar diagram, which shows the agent gender-wise distribution of the study sample. And this is the agent gender-wise distribution of the study sample. And this is the pie chart showing the gender distribution male and female. And the mean age of the hundred study sample was 37 years. It's a standard deviation of 17.16 years. With the highest 78 years and lowest seven years, they had 61% males and 39% females in the study and 33% samples were from 21 to 30 years age group and followed by 20% subjects from the 31 to 40 years age group. And this is the bar diagram showing the organ involved on the study sample with, which shows that the large bubble was majorly involved, it includes 33% followed by the small bubble and appendix. And this is the bar diagram showing the type of diseases and on the study sample, mostly were infected, which is followed by neoplastic and then inflammatory and others which were like surgical emergencies like introspection and all this. And this is the bar diagram showing the diagnosis among the study sample, which shows the neoplasm was the most common diagnosis among study subjects, which includes the adenocarcinoma lymphoma, followed by acute appendicitis. And there are surgical emergencies like introspection and wallblasts were also present, along with the Crohn's disease, which is 17% and abdominal cough, which is 18%. And this is the table showing the disease of type of disease according to organ involved among the study sample. Appendicular diseases are mainly infected among the study subjects, whereas large bubble included both inflammatory and neoplastic whereas small bubble mostly they were infected. And this is the table showing the sensitivity of the test as per organ involved among study sample and overall CT scan was more sensitive to detect abdominal diseases than USG. And USG was as sensitive as CT scan to detect appendicular diseases, whereas for the rest of the organs it was approximately 50% less sensitive than CT scan. And this is the table showing sensitivity of the test as per type of disease among study sample. This was CT scan was the most effective for diagnosing neoplastic and other lesions like interception or wallblasts and the infective diseases can be diagnosed on ultrasound or CT with more than 70% sensitivity. And this is the table showing sensitivity of ultrasound and comatode tomography as per diagnosis among study sample. And the CT scan of the abdomen can detect 100% surgical emergencies like epiglute appendicitis, appendicular myococytes, interception, diverticulitis, and also the wallblasts. And the CT scan having almost double sensitivity for diagnosis including like chronic diseases like neoplasm, Crohn's disease than IUSG and USG having least sensitivity of 16% for the diagnosis of the ulcerative pulitis. And this is the cases which we have images of the cases which we have obtained. And this is the ultrasound image of the case of the Crohn's disease which shows the normal ilium with the viral wall technique shown in the ascending polon and the cecum. And there is increased vascularity, eccentric vascularity noted and there are multiple enlarged lymph nodes, eccentric lymph nodes. And this is the CT images obtained for the case of the ulcerative active Crohn's disease which showed the increase in eccentric vascularity. And there is a wall wall technique noted in the ilium, distalilium ascending polon and the cecum. And this is the ultrasound image showing the viral wall technique and surrounding fat stranding in the case of the ulcerative colitis. And this is the ultrasound images and CT images of the case of colonic interception with a large submucous lipoma which shows the target, characteristic target sign appearance on the ultrasound. And there's the CT and the transition point was not, the leading point was noted as the submucous lipoma which was a hyperequic on ultrasound and was hypodense on CT. And these are the ultrasound images for the case of the appendicular perforation which is noted at the base of the appendix, which is identified by the hyperequic foci noted and the normal iliocecal junction was noted. We also have a fairly defined heterogeneously hypoequic abscess which is noted near the appendix. And these are the ultrasound images of the case of abdominal tuberculosis which shows the iliocecal junction wall thickening with the surrounding necrotic and multiple conglomerated lymph nodes. And this is the CT scan which showing the bubble wall thickening with the surrounding fat stranding which is involving mainly the iliocecal junction and terminal ilium. And this is the case of retinocasin of the ascending colon. Here we can see there is the short segment thickening of the ascending colon and the cecum and there is a normal, you can see there is an incompetent, significantly incompetent iliocecal wall and significantly dilated ilium and ascending colon, ilium and the cecum. And here we on the CT scan we can see heterogeneously enhancing ascending colon with mild fat stranding noted and discussion. In our study a total of 100 patients with bowel disorders were studied using ultrasound and CT and 25 patients were diagnosed with appendicular pathologies. And 25 cases with primary neoplasm, 18 were abdominal coax and 17 were Crohn's disease, 6 were ulcerative colitis, 4 were wallblasts and 3 were diverticulitis and 2 were inter-subruption. Equid appendicitis was the most frequent finding seen in 23 patients and ultrasound was diagnostic in all except one case. Whereas bowel thickening was seen in most disorders and was seen in both ultrasound and computer tomography. And no customer was the most common finding among the neoplasm and was frequent in the old age group and heterogeneous post contrast enhancement with a non-necrotic and non-enhancing metastatic lymph nodes were helping understanding the extent of the involvement and treatment. And the hepatic metastasis and contiguous organ involvement were much less commonly seen in the vascular encasement which is sign of the nonoperability was not seen in our study. In our study, ultrasound was used an initial modality of choice for evaluation of patients. The study showed high specificity and sensitivity in cases like acute appendicitis, inter-subruption and appendicular mucosil. It provides a modality for effective real-time evaluation of bowel loops. In cases of dilated bowel loops likely wallblasts, it is ineffective in assessing the cause and transition point. Differential thickening of the various layers of the bowel wall can be assessed in real-time and they can be helped in the cases of ulcerative colitis where there is thickening and involvement of fully mucosa and submucosa. It is mostly seen in the ultrasound. And CT scan is a diagnostic modality of choice in the bowel and intestinal disorders. In our study, in only two cases, there were differences among the findings obtained in the final diagnosis. And a case of abdominal TB was diagnosed as Crohn's and a case of bacterial colitis was diagnosed as Ulcerative colitis. And the incidental findings like micro-diverticulum and interception were evidently on CT scans. And the conclusion in the last decade, many cross-sectional imaging techniques have evolved as superior alternatives to folloscopic imaging in examination of the small and large bowel. In particular trans-abdominal ultrasound will be regarded as the first imaging procedure in diagnostic work-up and follow-up of the bowel disease. Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using USG first and then CT only in those with negative or inconclusive USG results invest the sensitivity and lowers exposure to radiation. And whereas CT measures fewer cases than ultrasound, but both USG and CT can reliably detect common diagnosis among crossing acute abdominal pain. And these are the references. Thank you.