Post-Ischemic Bowel Stricture: CT Features in Eight Cases

Abstract

ObjectiveTo investigate the characteristic radiologic features of post-ischemic stricture, which can then be implemented to differentiate that specific disease from other similar bowel diseases, with an emphasis on computed tomography (CT) features.Materials and MethodsEight patients with a diagnosis of ischemic bowel disease, who were also diagnosed with post-ischemic stricture on the basis of clinical or pathologic findings, were included. Detailed clinical data was collected from the available electronic medical records. Two radiologists retrospectively reviewed all CT images. Pathologic findings were also analyzed.ResultsThe mean interval between the diagnosis of ischemic bowel disease and stricture formation was 57 days. The severity of ischemic bowel disease was variable. Most post-ischemic strictures developed in the ileum (n = 5), followed by the colon (n = 2) and then the jejunum (n = 1). All colonic strictures developed in the “watershed zone.” The pathologic features of post-ischemic stricture were deep ulceration, submucosal/subserosal fibrosis and chronic transmural inflammation. The mean length of the post-ischemic stricture was 7.4 cm. All patients in this study possessed one single stricture. On contrast-enhanced CT, most strictures possessed concentric wall thickening (87.5%), with moderate enhancement (87.5%), mucosal enhancement (50%), or higher enhancement in portal phase than arterial phase (66.7%).ConclusionPost-ischemic strictures develop in the ileum, jejunum and colon after an interval of several weeks. In the colonic segment, strictures mainly occur in the “watershed zone.” Typical CT findings include a single area of concentric wall thickening of medium length (mean, 7.4 cm), with moderate and higher enhancement in portal phase and vasa recta prominence.

Ultrasonographic and histopathological features in 8 cats with fibrotic small intestinal stricture

“…This is followed by a reparative phase with granulation tissue formation, chronic inflammation, and mural fibrosis, and a delayed phase associated with stenosis. This course accounts for the protracted waxing and waning clinical history encountered with intestinal stricture, often with temporary improvement, finally presenting with delayed signs of bowel obstruction . The histopathological changes and protracted clinical progression in the cats in this report closely correlate this pattern of ischemic intestinal disease.…”

“…Multiple factors may be implicated and the etiology may indeed differ between annular and long‐segment strictures. In humans, bowel stricture is usually recognized as a complication of chronic inflammatory intestinal diseases (particularly Crohn's disease) but is also associated with adhesions, bowel incarceration, the use of non‐steroidal anti‐inflammatory drugs, ischemia, and neoplasia . The principal underlying factors implicated in the development of stricture are bowel inflammation, bowel ischemia, and direct mucosal damage , .…”

“…A benign intestinal stricture is a circumscribed narrowing of the intestinal lumen caused by inflammation, adhesion, incarceration, or cicatricial contracture (fibrostenotic stricture) . Strictures are usually solitary and the extent of the intestinal stenosis may be focal and annular or involve long segments of bowel, and result in partial or complete intestinal obstruction . Reports of benign stricture in the veterinary literature are rare but have been described in the dog as a post‐anastomotic complication, due to strangulation associated with spontaneous mesenteric hernia and secondary to rupture of a congenital intestinal diverticulum …”

Age of Data in Contemporary Research Articles Published in Representative General Radiology Journals

“…In total, 50 KJR (9101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354565758), 492 ER, and 254 Radiology articles reported original research studies analyzing patient data. Of these, 44 (88%; 95% CI: 75.8–94.8%) (910121314151617181920212324262728293031323435363738394041424344474849505152535455565758), 359 (73%; 95% CI: 68.9–76.7%), and 211 (83.1%; 95% CI: 78–87.2%) articles, respectively, revealed the start and end of data collection to the level of calendar month.…”

“…Of these, 44 (88%; 95% CI: 75.8–94.8%) (910121314151617181920212324262728293031323435363738394041424344474849505152535455565758), 359 (73%; 95% CI: 68.9–76.7%), and 211 (83.1%; 95% CI: 78–87.2%) articles, respectively, revealed the start and end of data collection to the level of calendar month. The point estimate value of this proportion was slightly larger in KJR than in ER and Radiology, although the difference was not statistically significant.…”