Many faces of acute bowel ischemia: overview of radiologic staging

Abstract

Acute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.

Imaging of intestinal vasculitis focusing on MR and CT enterography: a two-way street between radiologic findings and clinical data

“…GI involvement is far more common in Takayasu arteritis than GCA. Radiologic features may be similar to mesenteric ischemia caused by thromboembolism or non-occlusive causes [ 20 , 21 ]. The other differential diagnoses include atherosclerosis, connective tissue disorders, such as Marfan syndrome, Ehlers–Danlos syndrome, and Loeys–Dietz syndrome [ 12 , 22 ].…”

“…Imaging appearance of lupus enteritis can mimic CD, although the presence of ascites is not common in CD and should raise suspicion of serositis. Bowel ischemic changes may present mucosal hypoenhancement and serosal hyperenhancement on MRE suggestive for early to intermediate stage bowel ischemia compared to transmural necrosis seen at late-stage ischemia [ 21 ]. Similar imaging features might be reported in antiphospholipid antibody syndrome, which is characterized by thrombosis and/or recurrent early pregnancy loss and is highly associated with SLE.…”

Chronic mesenteric ischemia: causes, methods of diagnosis and treatment

“…В соответствии с рекомендациями Американского колледжа радиологии, КТА должна быть альтернативой первой линии традиционной селективной ангиографии [16]. При помощи КТА можно оценить не только протяженность пораженного сегмента артерии, степень стеноза или окклюзии, наличие или отсутствие кальциноза артерии, но и степень развития коллатералей, что позволяет определить наиболее оптимальную тактику лечения [17].…”

Letter to the editor: Pneumatosis in bowel ischemia: time to change the optics to improve patient care

“…We read with interest the article entitled ‘Many faces of acute bowel ischemia: overview of radiologic staging’ by Davarpanah A. et al [ 1 ] recently published in Insights into Imaging .…”