The current role of computerized tomography in inflammatory disease of the bowel

CT has had a major and still evolving role in the diagnosis and management of inflammatory diseases of the bowel. The advantages of CT over conventional contrast examinations in these conditions include direct visualization of the bowel wall, detection of extramural disease, definition of the type and severity of such disease, visualization of all of the abdominal structures in one examination, and the noninvasive nature of the procedure. The current role of CT in diagnosis and management of these disorders varies. In diverticulitis, we believe CT should be used as the primary method of investigation, as well as for evaluation of complications. If surgical resection is not contemplated, the CT diagnosis should be confirmed by CE. In most cases of appendicitis, the diagnosis is still most accurately made clinically; radiographic evaluation should be reserved for cases with atypical clinical presentations. We advocate the use of CT as the first diagnostic procedure in these patients; if CT does not offer conclusive evidence of the diagnosis, contrast enema can be performed. In Crohn's disease, conventional barium studies remain the examinations of choice for diagnosis; CT should be used to evaluate possible complications and as a guide for proper management. Inflammatory colitides other than Crohn's disease primarily affect the mucosa, and are therefore best evaluated by barium enema; CT offers little additional information in these disorders. In all cases, conventional contrast studies and CT should be considered complimentary rather than exclusive procedures. In difficult cases, both examinations may be needed for complete evaluation.