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Thickened gastrointestinal wall findings on computed tomography in children: a reason for endoscopy?
Steve B Min1, Cade M Nylund, Mazen I Abbas
1Department of Pediatrics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA. Steven.min@gmail.com
Insights
Bowel wall thickening on CT scans in children is a nonspecific finding. Inflammatory bowel disease (IBD) was diagnosed in 20% of patients, with lab tests helping to guide further evaluation.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Medical Imaging
Background:
- Bowel wall thickening on computed tomography (CT) scans in children can be concerning for inflammatory bowel disease (IBD).
- The clinical significance of this radiological finding in pediatric patients without a known underlying condition is not well-defined.
Purpose of the Study:
- To evaluate the clinical outcomes related to inflammatory bowel disease (IBD) in children presenting with abdominal pain and thickened bowel wall on CT scan.
- To determine the diagnostic yield of endoscopy and the predictive value of laboratory markers in this patient cohort.
Main Methods:
- Retrospective analysis of pediatric patients (2006-2010) with abdominal pain and CT-identified thickened bowel wall.
- Evaluation of endoscopic findings, clinical variables, laboratory data (erythrocyte sedimentation rate, C-reactive protein, albumin, platelet count), and follow-up assessments.
Main Results:
- Of 56 patients, 20% were diagnosed with IBD. Terminal ileum thickening was most common (54%).
- Endoscopy revealed chronic colitis in 11 patients (79% of those with positive findings).
- Abnormal inflammatory markers were significantly higher in the IBD group; no new IBD diagnoses emerged upon follow-up in non-endoscoped patients.
Conclusions:
- Thickened bowel wall on pediatric CT scans is a nonspecific finding.
- Laboratory evaluations, including erythrocyte sedimentation rate and C-reactive protein, can aid in differentiating patients who require further investigation.
- Endoscopy and histologic analysis are crucial for definitive diagnosis of IBD in select pediatric cases.
Objectives:
Bowel wall thickening on computed tomography (CT) scans in children may raise concern for inflammatory bowel disease (IBD). The significance of this radiological finding is unclear. Our purpose was to evaluate the clinical outcomes with regard to IBD in children with no known underlying disease, presenting with abdominal pain and thickened bowel wall on CT scan.
Methods:
A retrospective analysis of pediatric patients with abdominal pain and CT findings of thickened bowel wall was performed between 2006 and 2010. Endoscopic findings, clinical variables, and follow-up assessments were evaluated.
Results:
Fifty-six patients presenting with abdominal pain and thickened bowel wall findings on CT scan were identified. Overall, 30 (54%) had terminal ileum wall thickening, 17 (30%) had isolated colonic wall thickening, and 9 (16%) had other small bowel wall thickening. Of the 56 patients, 21 (38%) underwent endoscopy, of which 14 (67%) had positive findings-11 (79%) had histologic evidence of chronic colitis, and 5 (36%) had duodenitis/ileitis. Ultimately, 11/56 (20%) were diagnosed as having IBD, 8/56 (14%) with functional abdominal pain/constipation, 9/56 (16%) appendicitis, 10/56 (18%) infectious gastroenteritis, and 18/56 (32%) with miscellaneous diagnoses. Median levels of erythrocyte sedimentation rate, C-reactive protein, albumin, and platelet count were significantly abnormal in the IBD group compared to the non-IBD group. Additional follow-up of those who did not undergo endoscopic evaluation revealed no new diagnoses of IBD.
Conclusions:
The presence of thickened bowel wall on CT scans is a nonspecific finding in children. Laboratory evaluation may help distinguish which patients require additional evaluation and endoscopy.
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