Aims and objectives
Acute Small Bowel Ischemia (ASBI) is due to a sudden interruption of blood intake in a portion of small bowel; this leads to ischemia of the bowel segment involved,
cellular damage and bowel wall necrosis [1].
Although ASBI represents an uncommon cause of abdominal pain,
with a relatively low incidence (from 0.09% to 0.2% of all the admissions in an Emergency Department) [2-5],
a correct diagnosis and a prompt recognition of intestinal vascular impairment is mandatory,
since ASBI is linked to high morbility and mortality...
Methods and materials
From January 2015 to September 2017,
94 patients with abdominal pain and clinical-diagnostic suspect of ASBI,
primary or secondary to bowel obstruction,
have been admitted to the Department of General Surgery of our Emergency Hospital,
to undergo surgery in regime of emergency/urgency.
Patients with ASBI secondary to neoplasms,
vasculitis,
inflammatory bowel diseases and traumatic events were excluded from our sample,
due to the large number of comorbidities that could affect a correct evaluation of ASBI CT signs.
Before every surgical procedure,
an abdominal CT has...
Results
Results of our analysis are listed below:
Types of ASBI in our sample:
-7% of our patients had an evidence of ASBI from vascular (arterial/venous) occlusion;
- 12% of our sample had ASBI due to hypovolemic insult or a low flow state;
- in 81% of our cases,
ASBI was a consequence of bowel obstruction.
Analysis of every single CT sign associated with ASBI:
-Altered bowel wall enhancement and thickness resulted almost always present in patients with ASBI due to a vascular occlusion or a...
Conclusion
The results of our study confirm the importance of CT in suggesting a correct diagnosis of ischemia in all types of ASBI and stress the role of some imaging findings which have to be considered,
especially suspecting "primary" ASBI.
In fact,
patients with "primary" ASBI,
linked to a vascular occlusion or to a low flow state and therefore often without an evident cause of ischemia on CT (i.e.
bowel obstruction) have a more severe clinical and radiological picture.
Presence of CT signs like an altered...
Personal information
Submitting author:
Dr.
Marica Giannotta
Volunteer Radiologist in Emergency Radiology Department,
Ospedale Maggiore Carlo Alberto Pizzardi,
Bologna,
Italy
mail address:
[email protected]
Presenting author:
Dr.
Margherita Agostini
Radiology Resident in Department of Specialistic,
Diagnostic and Experimental Medicine,
Ospedale Sant'Orsola-Mapighi,
Bologna,
Italy
mail address:
[email protected]
Co-authors:
Dr.
Paolo Emilio Orlandi
Radiologist in Emergency Radiology Department,
Ospedale Maggiore Carlo Alberto Pizzardi,
Bologna,
Italy
mail address:
[email protected]
Dr.
Laura Mastrangelo
General Surgeon in Surgery Department,
Ospedale Maggiore Carlo Alberto Pizzardi,
Bologna,
Italy
mail address:
[email protected]
Dr.
Simone Nicosia
Surgery...
References
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Grabitz K et al.
(2015) The importance of open emergency surgery in...