CT Findings in Acute, Subacute, and Chronic Ischemic Colitis: Suggestions for Diagnosis

Abstract

Purpose. This paper aims at evaluating CT findings of occlusive and nonocclusive ischemic colitis (IC), in correlation with the etiology and the different phases of the disease. Materials and Methods. CT examination and clinical history of 32 patients with proven IC were retrospectively reviewed. The CT findings were analyzed according to the different phases of the disease (acute, subacute, and chronic). Results. Among the 32 CT examinations performed in the acute phase, 62.5% did not present signs of occlusion of the superior mesenteric artery (SMA) or inferior mesenteric artery (IMA), whereas IMA occlusion was detected in 37.5% of CT examinations. In the acute phase, the presence of pericolic fluid was found in 100% of patients undergoing progressive resorption from acute to subacute phase if an effective reperfusion occurred; the bowel wall thickening was observed in 28.1% patients in acute phase and in 86.4% patients evaluated in subacute phase. The unthickened colonic wall was found in all conditions where ischemia was not followed by effective reperfusion (71.9% of cases), and it was never found in chronic phase, when the colon appeared irregularly thickened. Conclusion. CT allows determining the morphofunctional alterations associated with the IC discriminating the occlusive forms from the nonocclusive forms. CT, furthermore, allows estimating the timing of ischemic damage.

Update on Colon Ischemia: Recent Insights and Advances

“…The most common CT findings included mesenteric fat stranding (88 %), bowel wall thickening (88 %), and abnormal colon wall enhancement (82 %), regardless of disease severity; pneumatosis linearis, bowel dilation, and peri-colonic free fluid were associated with severe ischemia, judged by 30-day colectomy and/or mortality [27]. Iacobellis et al found that timing of CT from the onset of symptoms reflected the evolution of disease and recovery [28]. If CI is a likely diagnosis, CT can be useful to elucidate the physiologic stage of disease.…”

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“…CT scan, colonoscopy and pathological study of the biopsies confirmed the colitis origin [3,4,16]. Ischemic colitis induced by ergotamine is fully resolved with the drug suspension, digestive rest, parenteral hydration and antibiotic therapy [20,21].…”

“…The presence of the following findings suggests the existence of ischemic colitis: the spare of the rectum, segmental area of injury and hemorrhagic nodules that can also be detected in x-ray scan (thumb printingsign) [3,4,15,16]. The treatment depends on the severity of the episode and its etiology.…”

Limited utility of MRA for acute bowel ischemia after portal venous phase CT

“…Elderly patients are more commonly affected [9] with a better prognosis than AMI (estimated mortality rate of about 20%) [10]. The majorities of these cases are nonocclusive in nature and result from hypoperfusion or are medication induced, although vascular occlusion can more rarely be identified [9,10]. The source of ischemia is frequently undiscovered, even after computed tomography (CT) or colonoscopy [10].…”

“…The source of ischemia is frequently undiscovered, even after computed tomography (CT) or colonoscopy [10]. Most cases of IC are mild and self-limited in course or responsive to supportive therapy [11], although up to 20% may progress to transmural necrosis and require surgical resection [9]. Patients with IC, like AMI, often presents with nonspecific symptoms such as crampy abdominal pain, tenesmus, and hematochezia [8].…”