Clinical Significance of Incidental Colorectal Wall Thickening on Computed Tomography Scan in African-American and Hispanic Patients

Abstract

We sought to assess the significance of an incidental finding of colorectal wall thickening (CRWT) on computed tomography (CT) scan in African-American and Hispanic patients. We retrospectively reviewed charts of African-American and Hispanic patients from January 1994 to December 2005. Those patients were included in whom the colonoscopy was performed due to incidental CRWT on CT scan. Patients with a history or a family history of colorectal malignancy, inflammatory bowel disease, or colorectal surgery, with an incomplete colonoscopic examination, or <18 years of age were excluded. Endoscopic and pathological findings were abstracted. Thirty-two patients met the criteria. Endoscopic examination was abnormal in 21 (65.6%). The positive predictive value of CRWT for abnormal endoscopic examination was 65.6%. Abnormal endoscopic examination revealed diverticulosis in 9 (43%), erythematous mucosa in 8 (38%), polyps in 6 (29%), mass in 2 (9%), thickened folds in 1 (5%), and diverticulitis in 1 (5%). Histopathological findings revealed colitis in 7 (33%), adenoma in 4 (19%), hyperplastic polyps in 4 (19%), adenocarcinoma in 2 (9%), lymphoid aggregates in 2 (9%), melanosis coli in 1 (5%), and normal in 1 (5%) in the abnormal examination group. Abnormal endoscopic examination was found in 65.6% of patients. The prevalence of colitis, adenomas, and malignancy was high, therefore abnormal CRWT warrants further endoscopic evaluation.

Incidental Colorectal Computed Tomography Abnormalities: Would You Send every Patient for a Colonoscopy?

“…Although the clinical significance of this finding is being disputed, it has been reported to reflect mainly inflammatory bowel disease, bowel ischemia or colorectal carcinoma (1,2). However, it may also represent an incidental finding or an artifact without clinical significance (3). The aim of the present study was to establish the value of colonoscopy in confirming incidental CT findings of the colon and, particularly, those of CRWT.…”

Computed tomography findings of bowel wall thickening: its significance and relationship to endoscopic abnormalities

“…[2][3][4][5][6][7][8][9][10][11][12] In addition, several reports in the literature have attempted to differentiate benign and malignant cases of BWT. [13][14][15] These studies are relatively small and, as yet, no consensus has emerged on how this issue should be tackled.…”

“…The use of magnetic imaging such as with Olympus ScopeGuide™, coMputed toMography findings of Bowel wall thicKening: its significance and relationship to endoscopic aBnorMalities UzzAMAN ALAM NAIR BORGSTEIN MELEAGROS which would give an accurate anatomical location of a lesion, 18,19 would have been useful to clarify the accuracy of endoscopic evaluation in locating lesions in this study. Rockey et al 2 and Padda et al 12 suggested that patients who have high clinical suspicion for GI pathology but a negative endoscopy should have a double contrast barium enema or repeat CT with emphasis on optimal luminal distension. CT colonography can also be considered as it can detect very small polyps missed during endoscopy.…”

Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit?

“…Colonic wall thickening is frequently encountered at CT and may be related to normal variants such as diverticular disease, inflammatory conditions, and neoplastic disease [1]. Because no uniform guidance exists, debate surrounds the clinical significance of bowel wall thickening found at CT when demonstrated by both abdominopelvic CT (APCT) or CT colonography (CTC) [2][3][4][5][6][7][8][9][10][11][12][13].…”

“…A common dilemma facing clinicians is how best to follow up a CT report describing colonic wall thickening [2][3][4][5][6][7][8]. In short, how confident can the referring clinician be with the radiologist's diagnosis to explain a new finding of colonic thickening?…”