Clinical and Endoscopic Significance of Bowel-Wall Thickening Reported on Abdominal Computed Tomographies in Symptomatic Patients with No History of Gastrointestinal Disease

Alkhowaiter, Saad; Brahmania, Mayur; Kim, Edward; Madden, Mark; Harris, Alison; Yoshida, Eric M.; Gray, James R.

doi:10.1016/j.carj.2012.01.002

Cited by 29 publications

(31 citation statements)

References 13 publications

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“…Al-Khowaiter et al studied 76 symptomatic patients with terminal ileal and/or colonic wall thickening and found that 76% of patients had various identifiable pathologies on colonoscopy, whereas 24% had normal colonoscopy. 8 In their study, IBD and infectious colitis were the most common causes of bowel wall thickening. We also found that 68% patients had an IBD, 2% had cancer, 8% patients had normal colonoscopy and histopathology (incidental ileocecal wall thickening), and 22% patients had nonspecific findings not attributable to a particular pathology.…”

Section: Discussionmentioning

confidence: 98%

“…Al‐Khowaiter et al studied 76 symptomatic patients with terminal ileal and/or colonic wall thickening and found that 76% of patients had various identifiable pathologies on colonoscopy, whereas 24% had normal colonoscopy . In their study, IBD and infectious colitis were the most common causes of bowel wall thickening.…”

Section: Discussionmentioning

confidence: 98%

“…On comparing CT features between the diseased and normal patients, we found that the involvement of cecum with ICJ and ascending colon, peri‐ileocecal stranding, and long‐segment stricture were significantly more common in patients with underlying disease. Al‐Khowaiter et al reported that “skip lesions” on CT (5%) were always associated with IBD . On the other hand, pancolitis reported on CT (11%) was associated with IBD in 25% of cases, infection in 50% of cases, and normal findings in 25% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…The bowel wall thickening could be a manifestation of underlying inflammatory, infectious, ischemic, or neoplastic pathology or may represent normal findings because of technical reasons, such as inadequate distension of the bowel. Previously, the significance of colonic wall thickness was evaluated by various studies, and most of the studies have concluded that patients with colonic wall thickness on CT should undergo colonoscopy and biopsy as a majority of these patients will have an underlying disease . This recommendation of endoscopy has been made because of the increased risk of neoplastic diseases in the colon.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, the significance of colonic wall thickness was evaluated by various studies, and most of the studies have concluded that patients with colonic wall thickness on CT should undergo colonoscopy and biopsy as a majority of these patients will have an underlying disease. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] This recommendation of endoscopy has been made because of the increased risk of neoplastic diseases in the colon. However, the significance of ileocecal wall thickening on CT has been infrequently evaluated.…”

Section: Discussionmentioning

confidence: 99%

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Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country

et al. 2018

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Background and Aim Clinical significance of ileocecal thickening on computed tomography (CT) is uncertain. We conducted this prospective study to determine the clinical relevance of ileal and/or cecal thickening on CT. Methods All patients with ileocecal thickening on CT were prospectively evaluated with ileocolonoscopy, biopsy, and other relevant investigations. Results Fifty patients (29 males, mean age 36.8 ± 13.21 years) were studied. Thirty nine (78%) patients presented with abdominal pain. On CT, 46 (92%) had a thickened wall of terminal ileum, 25 (50%) cecum, and 21 (42%) of both cecum and ileum. The mean wall thickness of ileum and cecum on CT was 7.23 + 3.2 mm and 5.5 + 3.1 mm, respectively. Final diagnosis was tuberculosis in 24 (48%) patients, Crohn's disease (CD) in 10 (20%), and adenocarcinoma in 1 patient. Colonoscopy demonstrated abnormal findings in 41 patients (82% patients with mucosal ulcerations being most common ( n = 20 (40%). Of 15 (30%) patients with ileocecal bowel wall thickening, 4 (8%) patients had normal colonoscopy and histopathology (incidental ileocecal wall thickening), and in the remaining 11 patients, histopathology showed non‐specific findings and these patients were asymptomatic without any specific treatment on last follow up ranging from 3 to 24 months. Involvement of cecum with ileocecal junction, ascending colon involvement, peri‐ileocecal stranding, and long‐segment stricture was significantly more common in patients with underlying disease as compared to nondiseased patients ( P < 0.05). Conclusion A majority of patients with ileocecal wall thickening on CT have an underlying disease and should be further investigated by ileocolonoscopy and biopsy.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country

et al. 2018

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Ileocecal thickening: Clinical approach to a common problem

et al. 2019

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Ileocecal thickening (ICT) is a common finding on radiological imaging. It can be caused by a variety of inflammatory, infectious, or neoplastic conditions, and evaluating a patient of ICT can be a challenging task. Intestinal tuberculosis (ITB), Crohn's disease (CD), and adenocarcinoma are the most common causes. Enteric bacterial infections, cytomegalovirus, histoplasmosis, amebiasis, systemic vasculitis, lymphoma, etc. should be suspected in appropriate clinical settings. However, it could often be a spurious or nonspecific finding. A thickness of more than 3 mm in a normally distended small bowel is usually considered abnormal. Detailed evaluation of imaging of the site and extent of thickening; the degree and pattern of thickening; and the associated findings, such as degree of fat stranding, fibrofatty proliferation, adjacent lymph nodes, and solid organ involvement, should be performed. Ileocolonoscopy is an important tool for diagnosing and obtaining samples for tissue diagnosis. Histopathology is usually the gold standard for diagnosis, although-not uncommonly-findings could be nonspecific, and reaching a definitive diagnosis is difficult. As such, a systematic approach with the integration of clinical, biochemical, radiological, endoscopic, histological, and other laboratory tests is the key to reaching a diagnosis. In this article, we review the causes of ICT and present a clinical approach for the management of ICT. Causes of ICTThe ileocecal area could be involved by a variety of conditions, including benign or malignant tumors, infections, inflammatory conditions, ischemia, etc. However, ICT can also be a spurious finding, without any underlying cause. In various studies on bowel wall thickening, a normal ileocolonoscopy has been found

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Predictors of colorectal carcinoma and inflammatory bowel disease in patients with colonic wall thickening

et al. 2022

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Background and Aim: Colonic wall thickening (CWT) is commonly associated with clinically significant pathologies, but predictive factors of such pathologies are not well known. This study aims to identify the predictors of clinically significant pathologies, such as colorectal carcinoma (CRC) and inflammatory bowel disease (IBD), in patients with CWT. Methods: Subjects with an abnormal abdominal computed tomography (CT) and a follow-up colonoscopy between 2010 and 2020 were retrospectively reviewed. Patients with CWT in the CT were included and examined in this study. A multivariable logistic regression analysis was performed to assess for factors independently associated with CRC or IBD in these subjects. Receiver operating characteristic (ROC) curve analysis was used to further examine significant parameters in multivariable logistic regression analysis. Results: Among 403 patients with CWT on CT scans who underwent a colonoscopy, 269 subjects who met the inclusion criteria were identified and studied. On multivariable logistic regression models, elevated platelet count, low hematocrit, and localized CWT were found to be independently associated with CRC, while elevated platelet count and younger age were independently associated with IBD. On ROC curve analysis for CRC, area under the curve (AUC) for hematocrit, platelets, and localized CWT was 0.76, 0.75, and 0.61, respectively. On ROC curve analysis for IBD, AUC for age and platelets was 0.90 and 0.69, respectively. Conclusion: Elevated platelet count, low hematocrit, and localized CWT can be potentially used as predictors of CRC in patients with CWT. Elevated platelet count and young age can be used to predict IBD in these patients.

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Clinical and Endoscopic Significance of Bowel-Wall Thickening Reported on Abdominal Computed Tomographies in Symptomatic Patients with No History of Gastrointestinal Disease

Abstract: Symptomatic patients who are found to have nonspecific BWT on CT should undergo definitive endoscopic investigation because the majority will have significant gastroenterologic disease, and only a minority will have a normal colonoscopy.

Cited by 29 publications

References 13 publications

Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country

Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country

Ileocecal thickening: Clinical approach to a common problem

Predictors of colorectal carcinoma and inflammatory bowel disease in patients with colonic wall thickening

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