CT Diagnosis of ileal diverticulitis

Macari, Michael; Balthazar, Emil J.; Krinsky, Glen; Cao, Huyen

doi:10.1016/s0899-7071(98)00006-0

Cited by 21 publications

(13 citation statements)

References 5 publications

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“…Focal small bowel wall thickening is generally found with neoplasms, endometriosis, small bowel diverticulitis, foreign body perforations, small bowel ulcers (secondary to non-steroidal anti-inflammatory drugs) and occasionally granulomatous processes like tuberculosis and Crohn's disease [16,[26][27][28][29][30]. Segmental involvement is found with intramural haemorrhage, Crohn's disease, lymphoma, infectious enteritis and ischaemia, particularly due to superior mesenteric artery (SMA) embolus or superior mesenteric vein (SMV) thrombosis [16,22,[31][32][33][34].…”

Section: Length Of Small Bowel Involvementmentioning

confidence: 99%

CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

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ABSTRACT. CT enterography is a new non-invasive imaging technique that offers superior small bowel visualisation compared with standard abdomino-pelvic CT, and provides complementary diagnostic information to capsule endoscopy and MRI enterography. CT enterography is well tolerated by patients and enables accurate, efficient assessment of pathology arising from the small bowel wall or surrounding organs. This article reviews the clinical role of CT enterography, and offers practical tips for optimising technique and accurate interpretation. Until recently, diagnosis of small bowel pathology had relied primarily on radiological techniques, in part due to the relative inaccessibility of the small bowel to conventional endoscopy. However, new endoscopic developments-notably the recent introduction of capsule endoscopy and double balloon enteroscopy-are challenging this position. Capsule endoscopy, for example, is now generally accepted as first-line investigation for occult gastrointestinal haemorrhage, and increasingly advocated for diagnosis of early Crohn's disease. However, the radiological community has not stood still. In parallel with the development of new endoscopic techniques, rapid progress has been made in crosssectional imaging technologies, harnessing the power of multidetector row CT (MDCT), MRI and ultrasound, facilitating rapid, accurate and minimally invasive investigation of the small bowel and adjacent tissues.CT enterography was first introduced by Raptopoulos et al [1] in 1997 as a modification to ''standard'' abdomino-pelvic CT examination to specifically examine the small bowel in detail, notably to assess the extent and severity of Crohn's disease [1,2]. They combined neutral (low-density) oral contrast with ''enteric phase'' CT to optimise contrast resolution between mucosa and lumen, thereby maximising conspicuity of abnormalities arising from the small bowel wall. Several authors have subsequently described similar techniques, which are broadly categorised into CT enterography (where patients drink oral contrast) and CT enteroclysis (luminal contrast is introduced via a nasojejunal tube placed fluoroscopically prior to CT examination). Although superior jejunal distension is attained using enteroclysis, the convenience, efficiency and superior patient experience achieved with CT enterography make it the preferred technique at the authors' institutions, and therefore the focus of this review. This paper will critically review the CT enterography technique and provide practical tips on interpretation to assist radiologists and help them avoid common interpretative pitfalls. We will also examine its role relative to other complementary non-ionising radiation radiological tests. TechniqueThe technique of CT enterography combines small bowel distension with a neutral or low-density oral contrast mixture and abdomino-pelvic CT examination during the enteric phase following administration of intravenous contrast. Patients drink approximately 1.5-2 l of oral contrast over 45-60 min. Patient comp...

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Section: Length Of Small Bowel Involvementmentioning

confidence: 99%

CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

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“…Although ultrasound is often requested by the clinicians as the initial examination in a patient presenting symptom of an acute abdomen, CT scan should be considered as the first choice in the evaluation of abdominal pain (2,5). CT imaging shows the presence of: 1) heterogeneous mass with air or fluid level, which appeared to be related to ileum along the mesenteric border, 2) uncomplicated diverticula elsewhere in the small bowel, 3) inflammation of mesenteric fat or dilated small bowel loop with thickened and enhanced wall (5).…”

Section: Discussionmentioning

confidence: 99%

“…About 6% -10% of patients with small bowel diverticulum may have acute complications such as hemorrhage, abscess, small bowel obstruction, perforation, fistula formation, and anemia as a result of mal absorption (1,(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Resection of Ileum Diverticulitis: A Case Report

Pazouki

Jamshidi

Alibeigi

et al. 2016

J Minim Invasive Surg Sci

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Introduction: Ileal diverticulum is a rare disease that presents with complications such as diverticulitis. Case Presentation: We present an 81-year-old man with partial small bowel obstruction having abdominal pain, nausea, vomiting for 48 hours and a mobile abdominal mass. After CT scan, exploratory laparoscopy and small bowel resection was done with primary anastomosis. Conclusions: When adhesion, internal hernia and malignancy are ruled out in patient presenting with partial obstruction and abdominal mass, other causes like diverticula must be considered.

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“…Diverticulitis, while predominantly a sigmoid disease, may also be seen in any portion of the colon (sigmoid 74 %, descending 21 %, transverse 3 %, and right 2 %) and may be seen in the small bowel [19,21,37,38,39,40,41]. Clinically, the possibility of diverticulitis may not be considered initially when symptoms are right-sided, due to the much higher incidence of appendicitis.…”

Section: Location Of Diverticulitismentioning

confidence: 99%

CT evaluation of appendicitis and diverticulitis. Part II: Diverticulitis

Rhea¹

2000

Emergency Radiology

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CT has become the primary imaging modality for evaluation of possible diverticulitis. In studies of patients taken to surgery for suspected diverticulitis without first undergoing CT, 25±33 % of resected specimens show no inflammation. The overall accuracy of CT in establishing or excluding the diagnosis is between 84 and 99 %. In patients without diverticulitis, an alternative diagnosis is seen in 50±58 % of cases. The appearance of carcinoma with perforation and diverticulitis may be the same, and, as a result, the degree of certainty in the diagnosis should be stated. Techniques include use of either oral and intravenous contrast or rectally administered contrast. No case of colonic perforation due to rectally administered water-soluble contrast for CT has been reported, although there have been cases of perforation using barium and fluoroscopy. All techniques scan the entire abdomen and pelvis since there are frequent alternative diagnoses seen beyond the area of initial pain.

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CT Diagnosis of ileal diverticulitis

Cited by 21 publications

References 5 publications

CT enterography: review of technique and practical tips

CT enterography: review of technique and practical tips

Laparoscopic Resection of Ileum Diverticulitis: A Case Report

CT evaluation of appendicitis and diverticulitis. Part II: Diverticulitis

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