Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review

Abstract

Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.

Phlebosclerotic colitis: an analysis of clinical and CT findings in 29 patients with long-term follow-up

“…Colonic ischemia is caused by markedly reduced blood supply leading to cellular metabolic dysfunction, colonic inflammation, ulceration or eventually necrosis [ 14 , 15 ]. Venous colonic ischemia is uncommon [ 15 , 16 ]. PC is a rare form of nonthrombotic venous colonic ischemia almost exclusively seen in individuals of Asian ancestry [ 1 – 13 ].…”

“…As seen in our patients, PC could manifest a great variety of symptoms ranging from severe abdominal pain to asymptomatic and thus to obtain a diagnosis solely based on clinical findings seemed impossible in clinical practice. In addition to noninvasive diagnosis of PC by demonstration of characteristic curvilinear mesenteric venous calcifications [ 5 – 11 ], CT could offer colonic wall, pericolic and peritoneal details which were crucial for treatment decision, particularly for those presented with acute abdomen [ 15 , 16 ]. Our result showed that the AA-group exhibited a significantly thicker colonic wall (mean ± SD, 10.5 ± 3.4 mm), more involved segments and pericolic inflammation than the CP-group and CS-group on initial CT.…”

Diagnostic Management of Gastroenteropancreatic Neuroendocrine Neoplasms: Technique Optimization and Tips and Tricks for Radiologists

“…For pancreatic lesions, the contrast study protocol should include the delayed phase for the detection of delayed enhancement presented by some fibrous tumors. CT is an excellent method for detecting complications secondary to GEP-NETs, such as a bowel obstruction, intussusception, or desmoplastic reaction, which are life-threatening diseases [ 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 ]. The right timing of the arterial phase is crucial for appropriate imaging.…”

The Role of CT-Angiography in the Acute Gastrointestinal Bleeding: A Pictorial Essay of Active and Obscure Findings

“…Identifying the source of the bleeding can be difficult due to the wide range of potential causes, the length of the gastrointestinal tract and the intermittent nature of the bleeding [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. The diagnostic and therapeutic approach is fully dependent on the nature of the bleeding and the patient’s haemodynamic status.…”