Gastrointestinal edema in cirrhotics. Radiographic manifestations and pathogenesis with emphasis on colonic...

The radiologic manifestations of gastrointestinal edema observed as a complication of liver cirrhosis are described. We reviewed 22 consecutive patients with colonic and small bowel edema and present forms of intestinal involvement previously not reported. The pathophysiology of bowel edema is discussed and an attempt is made to correlate several factors. Our studies suggest that the production of intestinal edema is the result of a complex mechanism involving multiple factors on both sides of the capillary membrane. What appears crucial is not the absolute level of any disruptive force, but rather, the combination of several factors: 1. the ability of the lymphatic system to handle excessive flow; 2. the oncotic pressure; 3. the hydrostatic pressure and portal hypertension with or without venous collaterals. In this context, portal hypertension seems to play a dominant role since it correlates best with intestinal edema and explains its usual distribution.