Acute bowel ischemia: Tips and tricks for a challenging diagnosis

Congress:

ECR 2018

Poster Number:

C-0351

Type:

Educational Exhibit

Keywords:

Obstruction / Occlusion, Acute, Diagnostic procedure, CT, Gastrointestinal tract, Emergency, Abdomen, CT-Enterography, Ischaemia / Infarction

Authors:

M. C. Terranova¹, A. Calandra², M. T. Anzelmo¹, A. Crapanzano¹, F. Vernuccio¹, S. Salerno¹, M. Midiri¹, G. Lo Re¹, R. Lagalla¹; ¹Palermo/IT, ²PALERMO, Pa/IT

DOI:

10.1594/ecr2018/C-0351

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0351

Fig. 1: Superior Mesenteric Artery Thrombosis: fat stranding and reduced...

Fig. 2: Portal pneumatosis in a patient with thrombosis of superior mesenteric artery...

Fig. 3: ABI in a 45 years old patient affected by LES-induced vasculitis.

Fig. 4: Veno-occlusive disease. Congestive edema of the submucosal layer with mucosal...

Learning objectives

The aim of this poster is to describe the main CT findings of the different types of Acute Bowel Ischemia.

Background

Acute bowel ischemia (ABI) is a potentially life-threatening condition (mortality rate of 50-90%) and one of the most challenging abdominal emergencies, since it can mimic other non-ischemic conditions with dramatically different treatment and prognosis [1]. Every radiologist must be familiar with the main CT findings of ABI and its complications, in order to reach correct and early diagnosis, thus guiding therapeutic approaches.

Findings and procedure details

ABI involves different stages of severity, from mucosal to transmural involvement - with different prognosis – and may have different pathogenesis which affects imaging features [1-3]: Bowel wall thickening is a typical feature of veno-occlusive disease (due to reduced outflow), or hypoperfusion states, and it’s due to mural edema and/or hemorrhage - the presence and degree of bowel wall thickening does not correlate with the severity of ischemic bowel wall damage [1-3]. On the contrary, arterial occlusive ischemia presents as “paper thin walled” due vascular...

Conclusion

Astrong clinical-radiological approach must be pursued for ABI detection, diagnosis, and treatment, since their timing is crucial for patient prognosis.

Personal information

Maria Chiara Terranova [email protected] Affiliation: University Hospital Policlinico P. Giaccone Via del Vepro 127, 90127 Palermo, Italy

References

1. Wiesner W et Al. CT of acute bowel ischemia. Radiology (2003) Mar;226(3):635-50 2. Rha SE et al. "CT and MR imaging findings of bowel ischemia from various primary causes." Radiographics 20.1 (2000): 29-42. 3. Furukawa A et al. "CT diagnosis of acute mesenteric ischemia from various causes." American Journal of Roentgenology 192.2 (2009): 408-416.