CT of small bowel ischemia

Chou, Chung Kuao; Mak, Chee-Wai; Tzeng, Wen-Sheng; Chang, Jinn-Ming

doi:10.1007/s00261-003-0073-3

Cited by 84 publications

(60 citation statements)

References 11 publications

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“…CT and magnetic resonance (MR) angiography are more sensitive techniques than Doppler imaging with respect to assessment of the extent of the thrombus within the portal venous system [56][57][58] . Definitive diagnosis of PVT can be obtained by MR imaging (MRI) and CT; the former provides a better evaluation of the extent of the thrombosis, particularly in the mesenteric vein, reaching a sensitivity and specificity of 98%-100%.…”

Section: Diagnosismentioning

confidence: 99%

Portal vein thrombosis in liver cirrhosis

Kinjo¹,

Kawanaka²,

Akahoshi³

et al. 2014

WJH

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Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Portal vein thrombosis; Liver cirrhosis; Thrombophilic factors; Anticoagulation; Splenectomy Core tip: Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis; however, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions. The understanding and information on the management of PVT in cirrhosis are incomplete. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.

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Section: Diagnosismentioning

confidence: 99%

Portal vein thrombosis in liver cirrhosis

Kinjo¹,

Kawanaka²,

Akahoshi³

et al. 2014

WJH

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“…However, the development of MDCT has greatly improved the Bleeding complications (due to anticoagulation) 6 Relaparotomy 4 Others (ascites, disorientation) 5 *Some patients had more than one complication sensitivity so that it is now greater than 90 % [13,14]. A CT scan of the abdomen is now the imaging study of choice for mesenteric ischaemia, because it is rapid, non-invasive, and widely available in most hospitals and provides specific information on the location of the occluded vessel and the presence of bowel ischaemia [15] by showing bowel wall thickening, mucosal enhancement, intramural air, dilatation, portal venous gas and pneumatosis [16][17][18]. Kirkpatrick and colleagues [13] suggested that CT angiography findings of portal venous gas, pneumatosis, or a combination of bowel wall thickening with venous thrombosis, solid organ infarction, or focal lack of enhancement of bowel wall to be criteria for the diagnosis of mesenteric ischaemia; with sensitivity and specificity rates of 96 % and 94 %, respectively.…”

Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischaemia—An Indian Perspective

et al. 2014

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In Western countries, acute mesenteric ischaemia is commonly due to arterial occlusion and occurs in patients who are usually in their seventh decade. A venous cause for intestinal gangrene has been reported in only about 10 %. We examined whether this was so in India and compared the clinical features of patients with mesenteric arterial and venous ischaemia and relate these to their ultimate prognosis. We studied retrospectively, the records of all patients admitted or referred to the department with a diagnosis of acute mesenteric ischaemia between January 1997 and October 2012, noting their demographic details and mode of presentation, the results of preoperative imaging and blood investigations, the extent of bowel ischaemia, and the length of bowel that was resected at operation and their outcome. There were 117 patients, 85 males and 32 females whose median age was 53 years. Mesenteric venous thrombosis was seen in 56 patients (48 %) and mesenteric arterial occlusion in 61 (52 %). Forty six patients died (39 %); 15 with venous occlusion (27 %) and 31 with arterial occlusion (51 %). Compared to patients with arterial occlusion, the patients with venous obstruction were younger, had a longer duration of symptoms, were less frequently hypotensive at presentation, had higher platelet counts, had a shorter length of bowel resected, had fewer colonic resections and had a lower mortality. Other predictors of mortality on multivariate analysis were a longer duration of symptoms, lower serum albumin and higher creatinine levels at presentation and a shorter length of residual bowel. In India, acute mesenteric ischaemia in tertiary care centres is due to venous thrombosis in almost half of the patients who are at least a decade younger than those in the West. Significant predictors of mortality include low serum albumin and raised creatinine levels, a shorter residual bowel length and an arterial cause for mesenteric ischaemia.

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“…Reduced enhancement is also associated with infarction 46 . In cases of incomplete arterial occlusion, arterial occlusion with reperfusion and other causes of intestinal ischemia, increased bowel wall enhancement is more commonly evident.…”

Section: Abnormal Wall Enhancementmentioning

confidence: 99%