MDCT in acute ischaemic left colitis: a pictorial essay

Grezia, Graziella Di; Gatta, Gianluca; Rella, Roberta; Iacobellis, Francesca; Berritto, Daniela; Musto, Lanfranco; Grassi, Roberto

doi:10.1007/s11547-018-0947-7

Cited by 11 publications

(4 citation statements)

References 10 publications

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“…Acute intestinal toxicity presents with diarrhea, while malabsorption is the main clinical feature in chronic enteropathy [ 9 ]. In the first days/weeks after RT, small bowel dilation with submucosal edematous thickening and mucosal enhancement after contrast injection are observed at cross sectional imaging [ 9 , 65 ]. In chronic phase, the bowel loops are tethered with altered motility.…”

Section: Imaging Findingsmentioning

confidence: 99%

Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

et al. 2021

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Newer biologic drugs and immunomodulatory agents, as well as more tolerated and effective radiation therapy schemes, have reduced treatment toxicity in oncology patients. However, although imaging assessment of tumor response is adapting to atypical responses like tumor flare, expected changes and complications of chemo/radiotherapy are still routinely encountered in post-treatment imaging examinations. Radiologists must be aware of old and newer therapeutic options and related side effects or complications to avoid a misinterpretation of imaging findings. Further, advancements in oncology research have increased life expectancy of patients as well as the frequency of long-term therapy-related side effects that once could not be observed. This pictorial will help radiologists tasked to detect therapy-related complications and to differentiate expected changes of normal tissues from tumor relapse.

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Section: Imaging Findingsmentioning

confidence: 99%

Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

et al. 2021

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“…The American College of Radiology (ACR) guidelines recommend CT as the first imaging technique as an alternative to mesenteric angiography for the assessment of IC [85]. CT gives prompt information, with positive findings in ischemic colitis in up to 98% of cases [86,87]. IC is frequently related with non-occlusive etiology, but CT angiography with multiplanar reconstructions along multiple planes is useful to assess the luminal patency of the celiac trunk, SMA, IMA and their main branches, with a high sensitivity and specificity (93.3% and 95.9%, respectively) [88].…”

Section: Imaging Findingsmentioning

confidence: 99%

Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review

Iacobellis

Narese

Berritto³

et al. 2021

Diagnostics

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Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.

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“…Most CT findings are nonspecific so clinical presentation combined with CT findings can support the diagnosis [33]. With enhanced CT image definition, the various phases of ischemic insult and resolution can be defined [34]. It is most important to know the signs of colonic necrosis on CT including portal venous gas, toxic megacolon, and pneumatosis linearis [35] as they are associated with high rates of colectomy and mortality requiring prompt aggressive management [36].…”

Section: Computed Tomographymentioning

confidence: 99%

Bad blood: ischemic conditions of the large bowel

Rizwan

Feuerstadt

2021

Current Opinion in Gastroenterology

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Purpose of reviewColon ischemia is the most common form of intestinal ischemic injury and is seen frequently in an elderly population. This disease is usually self-limited, and many causes have been identified. The recent literature has focused on estimates of prognosis, triaging appropriate level of care, and identification of optimal treatments. In this review, we will address our current understanding of colon ischemia including epidemiology, pathophysiology, segmental distribution, presentation, diagnosis, and management. Recent findingsResearch has recently been focused on factors associated with poor outcome. The medical comorbidities identified include chronic obstructive pulmonary disease (COPD), hepatic cirrhosis, and chronic aspirin use. Serological markers are noninvasive tools that can triage severity. Recent studies have shown procalcitonin, C-reactive protein, D-dimer, and neutrophil counts can help predict those at greatest risk for poor outcome. The timing of colonoscopy relative to symptomatic onset also can help predict severity. Early colonoscopy allows for quicker identification of ischemic stigmata, reducing the chance of misdiagnosis and potentially unnecessary and harmful treatment. The treatment of colon ischemia has classically been conservative with antimicrobials reserved for those with moderate or severe disease. Recent retrospective analysis calls into question the utility of antibiotics in the treatment of colon ischemia, although the data is not convincing enough to advise against antimicrobial treatment in patients with severe and fulminant disease.

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MDCT in acute ischaemic left colitis: a pictorial essay

Cited by 11 publications

References 10 publications

Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review

Bad blood: ischemic conditions of the large bowel

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