CT of small bowel ischemia

Area of Science:

• Radiology
• Gastroenterology
• Surgical Pathology

Background:

• Small bowel (SB) ischemia and necrosis are critical conditions requiring accurate diagnostic tools.
• Computed tomographic (CT) imaging is frequently used to evaluate abdominal pathologies.
• Correlating CT findings with clinical outcomes is essential for patient management.

Purpose of the Study:

• To evaluate CT features of small bowel (SB) ischemia and necrosis.
• To correlate these CT findings with patient prognosis and clinical outcomes.
• To identify specific CT signs indicative of bowel necrosis and poor prognosis.

Main Methods:

• Retrospective review of 68 surgically or angiographically proven cases of SB ischemia.
• Classification of CT features into three groups based on bowel wall thickness and associated findings.
• Evaluation of factors including bowel wall enhancement, SB dilatation, mesenteric edema, and vascular occlusion.
• Comparison of bowel necrosis rates and mortality using the chi-square test.

Main Results:

• Intramural gas and SB dilatation in thinned bowel walls (Group A) were associated with high necrosis rates (100% and 81%).
• Poor mucosal enhancement in thickened bowel walls (Groups B and C) indicated higher necrosis rates (86% and 100%).
• Intramural gas was the only CT finding significantly associated with higher mortality (75%).

Conclusions:

• Intramural gas in a thinned small bowel wall is a strong indicator of bowel necrosis.
• Poor mucosal enhancement in a thickened small bowel wall also suggests bowel necrosis.
• The presence of intramural gas on CT scans signifies a poor patient prognosis in cases of small bowel ischemia.