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2013 ; 13
(53
): 155-66
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Ultrasound of selected pathologies of the small intestine
#MMPMID26672622
Smereczy?ski A
; Starzy?ska T
; Ko?aczyk K
J Ultrason
2013[Jun]; 13
(53
): 155-66
PMID26672622
show ga
Intestines, especially the small bowel, are rarely subject to US assessment due
to the presence of gases and chyme. The aim of this paper was to analyze
ultrasound images in selected pathologies of the small intestine in adults,
including the aspects of differential diagnosis. MATERIAL AND METHODS: In
2001-2012, abdominal ultrasound examinations were conducted in 176 patients with
the following small bowel diseases: Crohn's disease (n=35), small bowel
obstruction (n=35), yersiniosis (n=28), infectious diarrhea (n=26), bacterial
overgrowth syndrome (n=25), coeliac disease (n=15) and small bowel ischemia
(n=12). During examinations patients were fasting and no other particular
preparations were needed. Convex transducers of 3.5-6 MHz and linear ones of 7-12
MHz were used. The assessment of the small intestine in four abdominal quadrants
constituted an integral element of the examination. The following features of the
small bowel ultrasound presentation were subject to analysis: thickness and
perfusion of the walls, presence of thickened folds in the jejunum, reduction of
their number, presence of fluid and gas contents in the intestine, its
peristaltic activity, jejunization of the ileum and enteroenteric
intussusception. Furthermore, the size of the mesenteric lymph nodes and the
width of the superior mesenteric artery were determined and the peritoneal cavity
was evaluated in terms of the presence of free fluid. RESULTS: Statistically
significant differences were obtained between the thickness of the small
intestine in Crohn's disease or in ischemic conditions and the thickness in the
remaining analyzed pathological entities. Small bowel obstruction was manifested
by the presence of distended loops due to gas and fluid as well as by severe
peristaltic contractions occurring periodically. In the course of ischemic
disease, the intestinal walls were thickened without the signs of increased
perfusion and in the majority of cases intestinal stenosis was observed. Fluid in
the intestine was detected in all patients with coeliac disease, gas in 86.7% of
patients, thickening of the folds in the jejunum in 86.7%, their reduction in
80%, increased (enhanced) peristalsis in 93.3% and jejunization in 40%. In 80% of
coeliac disease cases, the intestine showed the features of hyperemia on color
Doppler examination and in 53.3% of patients the dilated lumen of the superior
mesenteric artery was detected. Enlarged mesenteric lymph nodes were visualized
in 73.3% of the subjects, enteroenteric intussusception in 33.3% and free fluid
in the peritoneal cavity in 60%. CONCLUSIONS: Small bowel obstruction is
manifested by the presence of evidently dilated intestinal loops filled with gas
and fluid and periodical severe deepened peristalsis.Ischemic changes and Crohn's
disease are characterized by the presence of fragmentarily thickened intestinal
walls and intestinal stenosis. Moreover, in Crohn's disease, increased wall
perfusion and mesenteric adenomegaly is encountered.Coeliac disease is manifested
by: increased amount of fluid mainly in the jejunum, thickened and hyperemic
jejunal walls, increased peristalsis;hypertrophied mucosal folds - often their
number is reduced, jejunization and transient enteroenteric
intussusception;ultrasound changes that require the differentiation with small
intestinal bacterial overgrowth syndrome and, to a lesser degree, with infectious
diarrhea.
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