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CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings

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ABSTRACT

Acute abdominal pain may result from a wide variety of medical and surgical diseases. One of these diseases is small bowel ischemia, which may result in a catastrophic outcome if not recognized and treated promptly. Computed tomography (CT) by its faster image acquisition, thinner collimation, high resolution, and multiplanar reformatted images has become the most important imaging modality in evaluating the acute abdominal conditions. In this article, the author presents a description of the histology of the small bowel, pathophysiology of small bowel change, and a correlation of the pathologic and CT findings of the small bowel injuries due to impaired venous drainage. A convincing correlation of the microscopic mucosal condition with the enhancement pattern of the thickened small bowel wall on CT is useful in definitely describing the mucosal viability.

No MeSH data available.


Related in: MedlinePlus

A 44-year-old woman with an adhesion-induced hernia in the pelvic cavity. (A) Photomicrograph (hematoxylin and eosin stain, original magnification ×40) shows the surgical margin of a resected small-bowel segment and a normal Kerckring fold (KF). Covering the surface of the fold is an aggregation of numerous villi (V), which forms the mucosa (bounded by dotted lines). These are visible on computed tomography. Although the underlying submucosa (SM) is slightly edematous, the core of the Kerckring fold remains uninvolved. (B) Photomicrograph (hematoxylin and eosin stain, original magnification ×200) shows that the villi are slender, covered by epithelium (E), and well separated from each other. They are approximately 0.5–1.0 mm tall. The mucosa at the surgical margin was judged viable, whereas the central portion of the resected bowel was necrotic (not shown). The basal lamina (BL) is barely visible, in contrast to the much thicker muscularismucosae (MM). CL = crypt of Lieberkühn; LP = lamina propria, the core of the villus
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Figure 1: A 44-year-old woman with an adhesion-induced hernia in the pelvic cavity. (A) Photomicrograph (hematoxylin and eosin stain, original magnification ×40) shows the surgical margin of a resected small-bowel segment and a normal Kerckring fold (KF). Covering the surface of the fold is an aggregation of numerous villi (V), which forms the mucosa (bounded by dotted lines). These are visible on computed tomography. Although the underlying submucosa (SM) is slightly edematous, the core of the Kerckring fold remains uninvolved. (B) Photomicrograph (hematoxylin and eosin stain, original magnification ×200) shows that the villi are slender, covered by epithelium (E), and well separated from each other. They are approximately 0.5–1.0 mm tall. The mucosa at the surgical margin was judged viable, whereas the central portion of the resected bowel was necrotic (not shown). The basal lamina (BL) is barely visible, in contrast to the much thicker muscularismucosae (MM). CL = crypt of Lieberkühn; LP = lamina propria, the core of the villus

Mentions: The intestinal wall consists of four layers. From the innermost to the outermost, these are the mucosa, the submucosa, the muscularis externa, and the serosa. Two structures are formed to augment the efficiency of absorption.[1819] First is the permanent shelf-like plicae circulares, also called valvulae conniventes or the Kerckring folds [Figure 1A], which involve both the mucosa and submucosa. They may achieve a height of 8–10 mm and a thickness of 3–4 mm.[18] Hence, they are discernible on CT (shown later). Second is the villus [Figure 1B]. The velvety, blanket-like intestinal mucosa is composed of innumerable villi, each approximately 0.5–1.5 mm long.[1819] Although an individual villus is not recognizable on CT, innumerable slender and sufficiently separated villi are aggregated to form the mucosa. It is visible as an enhancing layer on the thickened submucosa. The core of the villus, called the lamina propria, is covered by a simple columnar epithelium. Between the lamina propria and the surface epithelium is the basal lamina, which is only approximately 0.03–0.07 µm in thickness.[20] The mucosa receives 65% of the blood flow to the intestines[21] and is the most vulnerable layer to ischemic injury.


CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings
A 44-year-old woman with an adhesion-induced hernia in the pelvic cavity. (A) Photomicrograph (hematoxylin and eosin stain, original magnification ×40) shows the surgical margin of a resected small-bowel segment and a normal Kerckring fold (KF). Covering the surface of the fold is an aggregation of numerous villi (V), which forms the mucosa (bounded by dotted lines). These are visible on computed tomography. Although the underlying submucosa (SM) is slightly edematous, the core of the Kerckring fold remains uninvolved. (B) Photomicrograph (hematoxylin and eosin stain, original magnification ×200) shows that the villi are slender, covered by epithelium (E), and well separated from each other. They are approximately 0.5–1.0 mm tall. The mucosa at the surgical margin was judged viable, whereas the central portion of the resected bowel was necrotic (not shown). The basal lamina (BL) is barely visible, in contrast to the much thicker muscularismucosae (MM). CL = crypt of Lieberkühn; LP = lamina propria, the core of the villus
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036332&req=5

Figure 1: A 44-year-old woman with an adhesion-induced hernia in the pelvic cavity. (A) Photomicrograph (hematoxylin and eosin stain, original magnification ×40) shows the surgical margin of a resected small-bowel segment and a normal Kerckring fold (KF). Covering the surface of the fold is an aggregation of numerous villi (V), which forms the mucosa (bounded by dotted lines). These are visible on computed tomography. Although the underlying submucosa (SM) is slightly edematous, the core of the Kerckring fold remains uninvolved. (B) Photomicrograph (hematoxylin and eosin stain, original magnification ×200) shows that the villi are slender, covered by epithelium (E), and well separated from each other. They are approximately 0.5–1.0 mm tall. The mucosa at the surgical margin was judged viable, whereas the central portion of the resected bowel was necrotic (not shown). The basal lamina (BL) is barely visible, in contrast to the much thicker muscularismucosae (MM). CL = crypt of Lieberkühn; LP = lamina propria, the core of the villus
Mentions: The intestinal wall consists of four layers. From the innermost to the outermost, these are the mucosa, the submucosa, the muscularis externa, and the serosa. Two structures are formed to augment the efficiency of absorption.[1819] First is the permanent shelf-like plicae circulares, also called valvulae conniventes or the Kerckring folds [Figure 1A], which involve both the mucosa and submucosa. They may achieve a height of 8–10 mm and a thickness of 3–4 mm.[18] Hence, they are discernible on CT (shown later). Second is the villus [Figure 1B]. The velvety, blanket-like intestinal mucosa is composed of innumerable villi, each approximately 0.5–1.5 mm long.[1819] Although an individual villus is not recognizable on CT, innumerable slender and sufficiently separated villi are aggregated to form the mucosa. It is visible as an enhancing layer on the thickened submucosa. The core of the villus, called the lamina propria, is covered by a simple columnar epithelium. Between the lamina propria and the surface epithelium is the basal lamina, which is only approximately 0.03–0.07 µm in thickness.[20] The mucosa receives 65% of the blood flow to the intestines[21] and is the most vulnerable layer to ischemic injury.

View Article: PubMed Central - PubMed

ABSTRACT

Acute abdominal pain may result from a wide variety of medical and surgical diseases. One of these diseases is small bowel ischemia, which may result in a catastrophic outcome if not recognized and treated promptly. Computed tomography (CT) by its faster image acquisition, thinner collimation, high resolution, and multiplanar reformatted images has become the most important imaging modality in evaluating the acute abdominal conditions. In this article, the author presents a description of the histology of the small bowel, pathophysiology of small bowel change, and a correlation of the pathologic and CT findings of the small bowel injuries due to impaired venous drainage. A convincing correlation of the microscopic mucosal condition with the enhancement pattern of the thickened small bowel wall on CT is useful in definitely describing the mucosal viability.

No MeSH data available.


Related in: MedlinePlus