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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 54-year-old man with superior mesenteric venous thrombosis. (A). Early phase of computed tomographic arterioportography. The mucosa of the target-like, thickened wall (arrowhead) is hypodense to that of the uninvolved segment (arrow). (B). Delayed phase shows a contrary appearance. The mucosa of the thickened wall (arrowhead) becomes hyperdense to that of the uninvolved segment (arrow). These appearances reflect a slow blood inflow and delayed extravasation of molecules of the contrast material into the extravascular space, resulting in a prolonged mucosal enhancement in contrast to that of the normally circulated segment
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Figure 8: A 54-year-old man with superior mesenteric venous thrombosis. (A). Early phase of computed tomographic arterioportography. The mucosa of the target-like, thickened wall (arrowhead) is hypodense to that of the uninvolved segment (arrow). (B). Delayed phase shows a contrary appearance. The mucosa of the thickened wall (arrowhead) becomes hyperdense to that of the uninvolved segment (arrow). These appearances reflect a slow blood inflow and delayed extravasation of molecules of the contrast material into the extravascular space, resulting in a prolonged mucosal enhancement in contrast to that of the normally circulated segment

Mentions: Persistent enhancement of the thickened wall[28] is possibly related to slow blood flow and delayed extravasation of molecules of the contrast material into the extravascular interstitial space. This is corresponding to the angiographic demonstrations of a prolongation of the entire arterial phase and intense opacification of the thickened bowel wall.[29] This picture might not be perceived unless the enhancement of the other uninvolved segments has faded on a scan delayed long enough [Figure 8].


CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings
A 54-year-old man with superior mesenteric venous thrombosis. (A). Early phase of computed tomographic arterioportography. The mucosa of the target-like, thickened wall (arrowhead) is hypodense to that of the uninvolved segment (arrow). (B). Delayed phase shows a contrary appearance. The mucosa of the thickened wall (arrowhead) becomes hyperdense to that of the uninvolved segment (arrow). These appearances reflect a slow blood inflow and delayed extravasation of molecules of the contrast material into the extravascular space, resulting in a prolonged mucosal enhancement in contrast to that of the normally circulated segment
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 8: A 54-year-old man with superior mesenteric venous thrombosis. (A). Early phase of computed tomographic arterioportography. The mucosa of the target-like, thickened wall (arrowhead) is hypodense to that of the uninvolved segment (arrow). (B). Delayed phase shows a contrary appearance. The mucosa of the thickened wall (arrowhead) becomes hyperdense to that of the uninvolved segment (arrow). These appearances reflect a slow blood inflow and delayed extravasation of molecules of the contrast material into the extravascular space, resulting in a prolonged mucosal enhancement in contrast to that of the normally circulated segment
Mentions: Persistent enhancement of the thickened wall[28] is possibly related to slow blood flow and delayed extravasation of molecules of the contrast material into the extravascular interstitial space. This is corresponding to the angiographic demonstrations of a prolongation of the entire arterial phase and intense opacification of the thickened bowel wall.[29] This picture might not be perceived unless the enhancement of the other uninvolved segments has faded on a scan delayed long enough [Figure 8].

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