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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 30-year-old man with nonspecific abdominal pain. (A) On this non-enhanced scan, the collapsed small bowel (arrow) has a wall thickness larger than 1cm and an outer diameter of approximately 25mm. Its attenuation is lower than that of the adjacent muscle (arrowhead). (B) Strongly enhancing bowel (arrow) is brighter than the muscles (arrowhead) on this contrast-enhanced scan. The patient recovered uneventfully
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Figure 13: A 30-year-old man with nonspecific abdominal pain. (A) On this non-enhanced scan, the collapsed small bowel (arrow) has a wall thickness larger than 1cm and an outer diameter of approximately 25mm. Its attenuation is lower than that of the adjacent muscle (arrowhead). (B) Strongly enhancing bowel (arrow) is brighter than the muscles (arrowhead) on this contrast-enhanced scan. The patient recovered uneventfully

Mentions: First is in the non-distended jejunum. The normal Kerckring folds may reach a height of 8–10 mm and a width of 3–4 mm.[18] When these numerous folds crowd together in a non-distended jejunum, they may result in a wall thickened to 9–12 mm (plus the thickness of the submucosa and muscularis externa), with an outer diameter of approximately 18–25 mm. On the pre-enhancement scan, its density is lower than or similar to that of the muscle [Figure 13]. After the intravenous administration of contrast medium, scans show homogeneous and intense enhancement of the entire wall, which becomes brighter than the muscles. This finding should not be misinterpreted as a thickened wall without inner-layer enhancement, which suggests mucosal necrosis.


CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings
A 30-year-old man with nonspecific abdominal pain. (A) On this non-enhanced scan, the collapsed small bowel (arrow) has a wall thickness larger than 1cm and an outer diameter of approximately 25mm. Its attenuation is lower than that of the adjacent muscle (arrowhead). (B) Strongly enhancing bowel (arrow) is brighter than the muscles (arrowhead) on this contrast-enhanced scan. The patient recovered uneventfully
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 13: A 30-year-old man with nonspecific abdominal pain. (A) On this non-enhanced scan, the collapsed small bowel (arrow) has a wall thickness larger than 1cm and an outer diameter of approximately 25mm. Its attenuation is lower than that of the adjacent muscle (arrowhead). (B) Strongly enhancing bowel (arrow) is brighter than the muscles (arrowhead) on this contrast-enhanced scan. The patient recovered uneventfully
Mentions: First is in the non-distended jejunum. The normal Kerckring folds may reach a height of 8–10 mm and a width of 3–4 mm.[18] When these numerous folds crowd together in a non-distended jejunum, they may result in a wall thickened to 9–12 mm (plus the thickness of the submucosa and muscularis externa), with an outer diameter of approximately 18–25 mm. On the pre-enhancement scan, its density is lower than or similar to that of the muscle [Figure 13]. After the intravenous administration of contrast medium, scans show homogeneous and intense enhancement of the entire wall, which becomes brighter than the muscles. This finding should not be misinterpreted as a thickened wall without inner-layer enhancement, which suggests mucosal necrosis.

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