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Transmural Bowel Necrosis From Acute Mesenteric Ischemia and Strangulated Small-Bowel Obstruction: Distinctive CT

Paul Calame1, Alexandre Malakhia1, Celia Turco2

  • 1Service de Radiologie, CHU Besançon, 3 Blvd Fleming, Besançon, France 25000.

AJR. American Journal of Roentgenology
|September 26, 2019
PubMed

Insights

Computed tomography (CT) can differentiate transmural bowel necrosis causes. Nonocclusive acute mesenteric ischemia (AMI) shows pneumatosis intestinalis and portal venous gas, while strangulated small-bowel obstruction (SBO) presents with spontaneous hyperattenuation.

Area of Science:

  • Radiology
  • Gastroenterology
  • Abdominal Imaging

Background:

  • Transmural bowel necrosis is a critical condition with multiple etiologies.
  • Distinguishing between occlusive acute mesenteric ischemia (AMI), nonocclusive AMI, and strangulated small-bowel obstruction (SBO) is vital for timely intervention.
  • Computed tomography (CT) is a key imaging modality for diagnosing bowel necrosis.

Purpose of the Study:

  • To evaluate if transmural bowel necrosis exhibits distinct CT features based on its three primary causes: occlusive AMI, nonocclusive AMI, and strangulated SBO.
  • To identify specific CT findings that differentiate these etiologies.

Main Methods:

  • Retrospective analysis of contrast-enhanced CT scans from 77 patients with pathologically confirmed transmural bowel necrosis.
  • Independent review of CT scans by two abdominal radiologists to identify classic CT findings.
  • Statistical analysis to compare the frequency of CT findings across the three etiological groups.

Main Results:

  • Pneumatosis intestinalis and portal venous gas were significantly more prevalent in nonocclusive AMI compared to occlusive AMI and strangulated SBO.
  • Decreased or absent bowel wall enhancement and thinned bowel wall were more frequent in both types of AMI than in SBO.
  • Spontaneous hyperattenuation of the bowel wall was markedly more common in strangulated SBO than in either type of AMI.

Conclusions:

  • Transmural bowel necrosis demonstrates distinct CT characteristics correlating with its underlying cause.
  • Occlusive AMI is associated with absent bowel wall enhancement and less mesenteric fat stranding.
  • Nonocclusive AMI is characterized by a high incidence of pneumatosis intestinalis and portal venous gas.
  • Strangulated SBO typically presents with spontaneous bowel wall hyperattenuation and lacks pneumatosis intestinalis and portal venous gas.

Keywords:
CTacute mesenteric ischemiabowel infarctionretrospective studiesstrangulated small-bowel obstruction

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