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

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

A 3-year-old boy with volvulus. (A) Photomicrograph (hematoxylin and eosin stain, original magnification ×40) shows that the columnar architecture of the villi (bounded by dotted lines) is still maintained, even though all of the epithelium has been sloughed off (necrotic mucosa). (B) Photomicrograph (hematoxylin and eosin stain, original magnification ×200) demonstrates the swollen lamina propria (LP) of the villi, which is predominantly filled with red blood cells and necrotic tissue. Inflammatory cells are relatively few. The covering epithelia are all disrupted, sloughed, and not visible. This kind of villus is called a ghost villus. These swollen ghost villi are compact together, in contrast to those normal, sufficiently separated slender villi shown in Figure 1. Most villi are still confined by a basal lamina (BL). (C) Non-enhanced computed tomography (CT) scan depicts the target-like, thickened wall with a high-attenuating inner layer (arrow), which is nearly isodense to the adjacent muscles (arrowhead). This finding is compatible with a necrotic mucosa composed of closely contact, RBC-filled ghost villi, as shown in A. The submucosa is edematous or hemorrhagic. (D) On the contrast-enhanced CT scan, the inner layer (arrow) is not enhancing and has become hypoattenuating compared with the abdominal wall muscles (arrowhead), indicating poor blood supply to the mucosa. The edematous submucosa is enhanced and becomesisodense to hemorrhagic mucosa, even though still hypodense to muscles
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Figure 2: A 3-year-old boy with volvulus. (A) Photomicrograph (hematoxylin and eosin stain, original magnification ×40) shows that the columnar architecture of the villi (bounded by dotted lines) is still maintained, even though all of the epithelium has been sloughed off (necrotic mucosa). (B) Photomicrograph (hematoxylin and eosin stain, original magnification ×200) demonstrates the swollen lamina propria (LP) of the villi, which is predominantly filled with red blood cells and necrotic tissue. Inflammatory cells are relatively few. The covering epithelia are all disrupted, sloughed, and not visible. This kind of villus is called a ghost villus. These swollen ghost villi are compact together, in contrast to those normal, sufficiently separated slender villi shown in Figure 1. Most villi are still confined by a basal lamina (BL). (C) Non-enhanced computed tomography (CT) scan depicts the target-like, thickened wall with a high-attenuating inner layer (arrow), which is nearly isodense to the adjacent muscles (arrowhead). This finding is compatible with a necrotic mucosa composed of closely contact, RBC-filled ghost villi, as shown in A. The submucosa is edematous or hemorrhagic. (D) On the contrast-enhanced CT scan, the inner layer (arrow) is not enhancing and has become hypoattenuating compared with the abdominal wall muscles (arrowhead), indicating poor blood supply to the mucosa. The edematous submucosa is enhanced and becomesisodense to hemorrhagic mucosa, even though still hypodense to muscles

Mentions: When the villus is entirely denuded of its epithelial covering, it is called a ghost villus [Figure 2A and B]. This state represents mucosal necrosis. The lamina propria of the villus is bloated with extravasated fluid, intact or disrupted RBCs, inflammatory cells, and necrotic tissue. The submucosa is filled with various amounts of edematous and hemorrhagic components; edema usually predominates in the early stage. The Kerckring folds may be stretched and flattened if the submucosa is swollen enough. A massive amount of bloody exudate may leak from the submucosa and disrupted villi into the intestinal lumen, resulting in bloody stool. Finally, ischemic injury involves the muscularis externa and terminates with transmural necrosis of the bowel wall.


CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings
A 3-year-old boy with volvulus. (A) Photomicrograph (hematoxylin and eosin stain, original magnification ×40) shows that the columnar architecture of the villi (bounded by dotted lines) is still maintained, even though all of the epithelium has been sloughed off (necrotic mucosa). (B) Photomicrograph (hematoxylin and eosin stain, original magnification ×200) demonstrates the swollen lamina propria (LP) of the villi, which is predominantly filled with red blood cells and necrotic tissue. Inflammatory cells are relatively few. The covering epithelia are all disrupted, sloughed, and not visible. This kind of villus is called a ghost villus. These swollen ghost villi are compact together, in contrast to those normal, sufficiently separated slender villi shown in Figure 1. Most villi are still confined by a basal lamina (BL). (C) Non-enhanced computed tomography (CT) scan depicts the target-like, thickened wall with a high-attenuating inner layer (arrow), which is nearly isodense to the adjacent muscles (arrowhead). This finding is compatible with a necrotic mucosa composed of closely contact, RBC-filled ghost villi, as shown in A. The submucosa is edematous or hemorrhagic. (D) On the contrast-enhanced CT scan, the inner layer (arrow) is not enhancing and has become hypoattenuating compared with the abdominal wall muscles (arrowhead), indicating poor blood supply to the mucosa. The edematous submucosa is enhanced and becomesisodense to hemorrhagic mucosa, even though still hypodense to muscles
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A 3-year-old boy with volvulus. (A) Photomicrograph (hematoxylin and eosin stain, original magnification ×40) shows that the columnar architecture of the villi (bounded by dotted lines) is still maintained, even though all of the epithelium has been sloughed off (necrotic mucosa). (B) Photomicrograph (hematoxylin and eosin stain, original magnification ×200) demonstrates the swollen lamina propria (LP) of the villi, which is predominantly filled with red blood cells and necrotic tissue. Inflammatory cells are relatively few. The covering epithelia are all disrupted, sloughed, and not visible. This kind of villus is called a ghost villus. These swollen ghost villi are compact together, in contrast to those normal, sufficiently separated slender villi shown in Figure 1. Most villi are still confined by a basal lamina (BL). (C) Non-enhanced computed tomography (CT) scan depicts the target-like, thickened wall with a high-attenuating inner layer (arrow), which is nearly isodense to the adjacent muscles (arrowhead). This finding is compatible with a necrotic mucosa composed of closely contact, RBC-filled ghost villi, as shown in A. The submucosa is edematous or hemorrhagic. (D) On the contrast-enhanced CT scan, the inner layer (arrow) is not enhancing and has become hypoattenuating compared with the abdominal wall muscles (arrowhead), indicating poor blood supply to the mucosa. The edematous submucosa is enhanced and becomesisodense to hemorrhagic mucosa, even though still hypodense to muscles
Mentions: When the villus is entirely denuded of its epithelial covering, it is called a ghost villus [Figure 2A and B]. This state represents mucosal necrosis. The lamina propria of the villus is bloated with extravasated fluid, intact or disrupted RBCs, inflammatory cells, and necrotic tissue. The submucosa is filled with various amounts of edematous and hemorrhagic components; edema usually predominates in the early stage. The Kerckring folds may be stretched and flattened if the submucosa is swollen enough. A massive amount of bloody exudate may leak from the submucosa and disrupted villi into the intestinal lumen, resulting in bloody stool. Finally, ischemic injury involves the muscularis externa and terminates with transmural necrosis of the bowel wall.

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