Colonic wall thickening in patients with cirrhosis: CT findings and clinical implications

The purpose of this study was to determine the prevalence and spectrum of colonic wall changes in patients with cirrhosis and to determine the association between these colonic wall changes and portal hypertension.

Abdominal CT examinations of 57 patients with cirrhosis were evaluated for colonic abnormalities including bowel wall thickening and pneumatosis. The degree and extent of colonic involvement, other CT features of cirrhosis including ascites and portal hypertension, and clinical symptoms were recorded. A correlation was made with available colonoscopy, exploratory laparotomy, and pathologic results.

Colonic wall abnormalities were seen in 37% (21/57) of the patients with cirrhosis, 25% (14/57) of whom had isolated or predominantly right-sided colonic changes. Abnormal bowel wall thickening (ranging from 6 mm to 3 cm in thickness) was present in 35% of the patients. Pneumatosis was found in 4% of the patients. Of the 18 liver transplant recipients who had CT examinations before and after liver transplantation, colonic changes were seen in 44% preoperatively but in only 6% postoperatively. Isolated right-sided colonic changes and diffuse colonic changes were associated with varices in 93% and 100% of the patients, respectively; with ascites in 93% and 100%, respectively; and with splenomegaly in 83% and 86%, respectively. Specific or focal bowel symptoms were present in only 29% of the patients with colonic changes, whether the changes were diffuse or isolated to the right side.

Thirty-five percent of the patients with severe cirrhosis who underwent CT were shown to have colonic wall thickening; two thirds of these patients had thickening limited predominantly to the right colon. We postulated that predominantly right-sided colonic wall thickening may be related to changes in blood flow and hydrostatic pressures caused by portal hypertension. Many patients with isolated or predominately right-sided colonic wall thickening did not have specific or focal bowel symptoms, and in most patients, the colonic wall thickening resolved after successful liver transplantation, requiring no further testing. On the other hand, we found that pneumatosis or severe diffuse colonic wall thickening may indicate a more serious colonic problem such as ischemia or infection with Clostridium difficile and should prompt further investigation.