[Differential diagnosis of severe hypoechoic oedema of the small bowel]

To demonstrate the different causes of a marked and hypoechoic edema of the small bowel.

The study comprises patients over a period of 6 years with hypoechoic oedema of the intestinal tract, especially with cystic appearance of the valvulae conniventes. The causes of severe oedema were analysed retrospectively. Examinations were performed with ATL-, Siemens-, and GE-units using convex transducers (2 - 5 MHz) and high-frequency linear transducers (5 - 13 MHz).

Hypoechoic oedema of the small bowel with thickening of the valvulae conniventes was observed in 37 patients. The most frequent diagnoses in our series were small-bowel obstruction (n = 8), gastroenteritis (n = 5), peritonitis (n = 5), mesenteric venous thrombosis (n = 4), hereditary angiooedema (n = 3), tumorous infiltration of the mesentery (n = 3), and small bowel ischaemia (n = 2). Other reasons included one case of mesenteritis, renal insufficiency, vasculitis, use of ACE inhibitors, chemotherapy, intravenous drip after surgery, and protein loss in coeliac disease, respectively.

Severe oedema of the gastrointestinal tract is caused by many different diseases. Hypoechoic thickening of the valvulae conniventes is the typical sonographic sign. Additional clinical, anamnestic and pathohistological data are necessary in order to make a specific diagnosis.