Abstract
Purpose
This study aimed to correlate computed tomography (CT) findings and outcomes in patients affected by bowel infarction.
Materials and methods
Twenty-seven patients with bowel infarction due to vascular obstruction were evaluated with multidetector CT (MDCT) to establish the prognostic value of CT findings and their correlation with the origin of the ischaemia. The chi-square test was used to analyse the results (p≤0.05).
Results
MDCT images allowed recognition of the nature of ischaemia in all cases. In particular, arterial occlusion was found in 67% of patients and venous obstruction in 33%. The overall mortality rate was 63%. Outcome closely correlated with the kind of vascular obstruction, with a mortality rate of 89% in arterial forms and 11% in venous forms. Bowel-wall hyperdensity (2/9 venous occlusions), loss of wall enhancement (1/9 venous occlusions, 2/18 arterial occlusions) and wall thickening (8/9 venous obstructions, 2/18 arterial occlusions) were predictive of good outcome. Bowel-loop dilatation (4/9 venous occlusions, 13/18 arterial occlusions), intramural pneumatosis (1/9 venous occlusions, 17/18 arterial occlusions), mesenteric venous gas (2/9 venous occlusions, 11/18 arterial occlusions), portal venous gas (1/9 venous occlusions, 4/18 arterial occlusions), pneumoperitoneum (8/18 arterial occlusions) and pneumoretroperitoneum (1/18 arterial occlusions) were predictive of poor outcome. Ascites (6/9 venous occlusions, 12/18 arterial occlusions) did not add any prognostic information.
Conclusions
MDCT is able to detect the nature of bowel ischaemia and provide important prognostic information.
Riassunto
Obiettivo
Ricercare eventuali correlazioni tra informazioni ottenute con tomografia computerizzata (TC) e prognosi nell’infarto intestinale.
Materiali e metodi
Sono state valutate le immagini TC multidetettore (TCMD) di 27 pazienti con infarto intestinale da occlusione vascolare e sono state ricercate: significatività prognostica delle alterazioni evidenziate, correlazioni con la natura dell’ischemia. È stato applicato il test statistico del χ2 (p≤0,05).
Risultati
La TCMD ha riconosciuto sempre la natura dell’ischemia, secondaria ad occlusione arteriosa nel 67% dei casi e venosa nel 33%. Il tasso di mortalità complessivo è stato del 63%. L’eziologia della patologia in rapporto alla prognosi è risultata altamente significativa, con mortalità del 89% nelle forme arteriose e del 11% in quelle venose. L’iperdensità parietale (2/9 occlusioni venose), l’assenza di enhancement (1/9 occlusioni venose, 2/18 occlusioni arteriose), l’ispessimento di parete (8/9 occlusioni venose, 2/18 occlusioni arteriose) sono risultati significativi di evoluzione benigna, mentre la dilatazione delle anse (4/9 occlusioni venose, 13/18 occlusioni arteriose), la pneumatosi parietale (1/9 occlusioni venose, 17/18 occlusioni arteriose), l’aria nelle vene mesenteriche (2/9 occlusioni venose, 11/18 occlusioni arteriose), l’aria nei rami portali (1/9 occlusioni venose, 4/18 occlusioni arteriose), lo pneumoperitoneo (8/18 occlusioni arteriose) e il retropneumoperitoneo (1/18 occlusioni arteriose) sono risultati indici prognostici sfavorevoli. L’ascite (6/9 occlusioni venose, 12/18 occlusioni arteriose) non ha fornito indicazioni di tipo prognostico.
Conclusioni
La TCMD consente di definire la natura dell’ischemia intestinale e fornisce importanti valutazioni prognostiche.
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References/Bibliografia
Patak MA, Mortele KJ, Ros PR (2005) Multidetector row CT of the small bowel. Radiol Clin North Am 43:1063–1077
Angelelli G, Scardapane A, Memeo M et al (2004) Acute bowel ischemia: CT findings. Eur J Radiol 50:37–47
Wiesner W, Khurana B, Ji H et al (2003) CT of acute bowel ischemia. Radiology 226:635–650
Horton KM, Fishman EK (2007) Multidetector CT angiography in the diagnosis of mesenteric ischemia. Radiol Clin N Am 45:275–288
Wiesner W, Hauser A, Steinbrich W (2004) Accuracy of multidetector row computed tomography in a nonselected study population. Eur Radiol 14:2347–2356
Salzano A, De Rosa A, Carbone M et al (1999) Computerized tomography features of intestinal infarction: 56 surgically treated patients of which 5 with reversible mesenteric ischemia. Radiol Med 97:246–250
Klein HM, Lensing R, Klosterhalfen B et al (1995) Diagnostic imaging of mesenteric infarction. Radiology 197:79–82
Kassahun WT, Schulz T, Richter O et al (2008) Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review. Langenbecks Arch Surg 393:163–171
Yasuhara H (2005) Acute mesenteric ischemia: the challenge of gastroenterology. Surg Today 35:185–195
Aschoff AJ, Stuber G, Becker BW et al (2008) Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging. DOI: 10.1007/s00261-008-9392-8
Levy DA (2007) Mesenteric ischemia. Radiol Clin North Am 45:593–599
Kougias P, Lau D, El Sayed HF et al (2007) Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg 46:467–474
Dahlke MH, Asshoff L, Popp FC et al (2008) Mesenteric ischemia — Outcome after surgical therapy in 83 patients. Dig Surg 25:213–219
Park WM, Gloviczki P, Cherry KJ et al (2002) Contemporary management of acute mesenteric ischemia: Factors associated with survival. J Vasc Surg 35:445–452
Kasirajan K, Mascha EJ, Heffernan D et al (2004) Determinants of in-hospital mortality and length of stay for acute intestinal gangrene. Am J Surg 187:482–485
Angelelli G, Stabile Ianora AA, Lopez C et al (2003) Role of diagnostic imaging in intestinal diseases in advanced age (small intestine-colon). Radiol Med 106:94–98
Romano S, Romano L, Grassi R (2007) Multidetector row computer tomography findings from ischemia to infarction of the large bowel. Eur J Radiol 61:433–441
Hsu HP, Shan YS, Hsieh YH et al (2006). Impact of etiologic factors and APACHE II and POSSUM scores in management and clinical outcome of acute intestinal ischemic disorders after surgical treatment. World J Surg 30:2152–2164
Stöckmann H, Roblick UJ, Kluge N et al (2000) Diagnosis and therapy of nonocclusive mesenteric ischemia (NOMI). Zentralbl Chir 125:144–151
Yasuhara H, Niwa H, Takenoue T et al (2005) Factors influencing mortality of acute intestinal infarction associated with SIRS. Hepatogastroenterology 52:1474–1478
Bozlar U, Turba UC, Hagspiel KD (2007) Nonocclusive mesenteric ischemia: findings at multidetector CT angiography. J Vasc Interv Radiol 18:1331–1333
Ritz JP, Germer CT, Buhr HJ (2005) Prognostic factors for mesenteric infarction: multivariate analysis of 187 patients with regard to patient age. Ann Vasc Surg. 19:328–334
Kim AY, Ha HK (2003) Evaluation of suspected mesenteric ischemia. Efficacy of radiological studies. Radiol Clin N Am 41:327–342
Mansour MA (1999) Management of acute mesenteric ischemia. Arch Surg 134:328–330
Rhee RY, Gloviczki P (1997) Mesenteric venous thrombosis. Surg Clin North Am 77:327–338
Bartnicke BJ, Balfe DM (1994) CT appearance of intestinal ischemia and intramural hemorrage. Radiol Clin North Am 32:845–860
Horton KM, Fishman EK (2001) Multidetector row CT of mesenteric ischemia: can it be done? Radiographics 21:1463–1473
Saba L, Mallarini G (2007) Spiral computed tomography imaging of bowel ischemia: a literature review. Panminerva Med 49:35–41
Saba L, Mallarini G (2008) Computed tomography imaging findings of bowel ischemia. J Comput Assist Tomogr 32:329–340
Chou CK, Mak CW, Tzeng WS et al (2004) CT of small bowel ischemia. Abdom Imaging 29:18–22
St Peter SD, Abbas MA, Kelly KA (2003) The spectrum of pneumatosis intestinalis. Arch Surg 138:68–75
Gellett LR, Harries SR, Roobottom CA (2002) Urgent contrast enhanced computed tomography in the diagnosis of acute bowel infarction. Emerg Med J 19:480–481
Lassandro F, Scaglione M, Rossi G et al (2002) Portomesenteric vein gas: diagnostic and prognostic value. Emerg Radiol 9:96–99
Schindera ST, Triller J, Vock P et al (2006) Detection of hepatic portal venous gas: its clinical impact and outcome. Emerg Radiol 12:164–170
Chien-Hua L, Jyh-Cherng Y, Huan-Fa H et al (2007) Pneumatosis intestinalis and hepatic-portal-mesenteric venous gas in intestinal ischemia. Rev Esp Enferm Dig 99:96–99
Wiesner W, Mortele KJ, Glickman JN et al (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. Am J Roentgenol 177:1319–1323
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Moschetta, M., Stabile Ianora, A.A., Pedote, P. et al. Prognostic value of multidetector computed tomography in bowel infarction. Radiol med 114, 780–791 (2009). https://doi.org/10.1007/s11547-009-0422-6
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DOI: https://doi.org/10.1007/s11547-009-0422-6