Is CT Angiogram of the Abdominal Vessels Needed following the Diagnosis of Ischemic Colitis? A Multicenter Community Study

Abstract

Background. CT angiogram is frequently obtained after diagnosis of ischemic colitis (IC). Aims. To investigate the vascular findings of CT angiogram as compared to contrast-enhanced CT scan and whether this modality changes the management or prognosis of IC. Methods. We conducted a retrospective analysis of patients with IC from 2007 to 2013. Results. CT angiogram was performed in 34 patients (28.81%), whereas contrast-enhanced CT scan was performed in 54 patients (45.76%). In CT angiogram group, 8 patients (23.5%) had atherosclerotic changes. Stenosis was found in 12 patients (35.3%) (9: celiac trunk, 3: SMA). Among this group, one patient underwent colectomy and another underwent angioplasty of the celiac trunk who died within 30 days. Among contrast-enhanced CT scan group, 5 patients (9.3%) had atherosclerotic changes. Stenosis was found in 5 patients (9.3%) (3: celiac trunk, 1: SMA, and 1: IMA). Among this group, 3 patients had colectomy and one died within 30 days. There was no statistical difference between both groups in all vascular findings except the stenosis which was higher in CT angiogram group (P = 0.0025). Neither the need for surgery nor all-cause mortality was different between both groups. Conclusion. CT angiogram did not provide any useful findings that altered the management or the prognosis of IC.

Advents in the Diagnosis and Management of Ischemic Colitis

“…In more advanced but non-gangrenous forms of the disease, the CT will often show colonic wall thickening, thumbprinting, colonic dilatation, and pericolic fat stranding with or without the presence of ascitic fluid ( 46 ). The colonic wall thickening is usually circumferential following a homogeneous or heterogeneous pattern, depending on the degree of inflammation, edema, and/or bleeding (Figures 1 and 2 ) ( 35 , 53 – 55 ). The double halo or target sign may be present ( 54 ).…”

“…CT angiogram is often required as it offers the advantage of detecting abnormalities of the mesenteric vasculature due to atherosclerosis or thromboembolic events ( 35 , 58 ). It is frequently performed following the diagnosis of IC to look for the etiology of IC.…”

“…It is frequently performed following the diagnosis of IC to look for the etiology of IC. The rate of performing CT angiogram is several studies have ranged from 0 to 28.8% ( 35 , 58 ). Arterial stenosis of the IMA is often encountered in CT angiograms performed for the evaluation of patients with IC ( 59 ).…”

“…Arterial stenosis of the IMA is often encountered in CT angiograms performed for the evaluation of patients with IC ( 59 ). Although it has not presented superiority than the conventional contrast-enhanced CT scan, CT angiogram has additional disadvantages including increased exposure to radiation, potential nephrotoxicity due to contrast use, and increased costs ( 35 ). Therefore, it is reserved for severe cases especially with right colon involvement.…”

Ischemic Proctitis Presenting as Rectal Pain and Bloody Diarrhea with No Apparent Cause

“… 11 , 12 Abdominal CT with contrast or CT angiogram may be considered for patients with suspected underlying vascular disease, with recent intervention, or with unclear etiology; recent evidence suggests both diagnostic imaging tests have similar sensitivity. 13 The treatment of ischemic proctitis is largely supportive but can include surgery if the patient develops gangrenous, transmural rectal ischemia or severe bleeding. 14 …”