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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Br+J+Radiol
2016 ; 89
(1061
): 20150821
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MDCT in ischaemic colitis: how to define the aetiology and acute, subacute and
chronic phase of damage in the emergency setting
#MMPMID27007462
Berritto D
; Iacobellis F
; Mazzei MA
; Volterrani L
; Guglielmi G
; Brunese L
; Grassi R
Br J Radiol
2016[]; 89
(1061
): 20150821
PMID27007462
show ga
Ischemic colitis (IC) is the most common vascular disorder of the
gastrointestinal tract with a reported incidence of 6.1-44 cases/100,000 person
years with confirmatory histopathology. However, the true incidence of IC poses
some difficulty, and even vigilant clinicians with patients at high risk often
miss the diagnosis, since clinical presentation is non-specific or could have a
mild transient nature. Detection of IC results is crucial to plan the correct
therapeutic approach and reduce the reported mortality rate (4-12%). Diagnosis of
IC is based on a combination of clinical suspicion, radiological, endoscopic and
histological findings. Some consider colonoscopy as a diagnostic test of choice;
however, preparation is required and it is not without risk, above all in
patients who are severely ill. There are two manifestations of vascular colonic
insult: ischaemic and reperfusive. The first one occurs above all during
ischaemic/non-occlusive mesenteric ischaemia; in this case, the colonic wall
appears thinned with dilated lumen and fluid appears in the paracolic space. When
reperfusion occurs, the large bowel wall appears thickened and stratified,
because of subepithelial oedema and/or haemorrhage, with consequent lumen calibre
reduction. Shaggy contour of the involved intestine and misty mesentery are
associated with the pericolic fluid. The pericolic fluid results are a crucial
finding for IC diagnosis since its evidence suggests the presence of an ongoing
damage thus focusing the attention on other pathological aspects which could be
otherwise misdiagnosed, such as thinned or thickened colonic wall. Moreover, the
pericolic fluid may increase or decrease, depending on the evolution of the
ischaemic damage, suggesting the decision of medical or surgical treatment.
Radiologists should not forget the hypothesis of IC, being aware that
multidetector CT could be sufficient to suggest the diagnosis of IC, allowing for
early identification and grading definition, and in a short-term follow-up,
discriminating patients who need urgent surgery from patients in whom medical
treatment and follow-up can be proposed.