Transabdominal bowel sonography for the detection of intestinal complications in Crohn’s disease

Abstract

Background-The course of Crohn's disease is characterised by the occurrence of intestinal complications such as strictures, intra-abdominal fistulas, or abscesses. Standard diagnostic procedures may fail to show these complications, in particular fistulas. Aims-To test the value of transabdominal bowel sonography (TABS) for the detection of intestinal complications in Crohn's disease. Methods-TABS was prospectively performed in 213 patients with Crohn's disease in a university based inflammatory bowel disease referral centre. Thirty three underwent resective bowel surgery and were included in this study. The accuracy of TABS to detect strictures, intraabdominal fistulas, or abscesses was compared with surgical and pathological findings. Results-TABS was able to identify strictures in 22/22 patients and to exclude it in 10/11 patients (100% sensitivity, 91% specificity). Fistulas were correctly identified in 20/23 patients and excluded in 9/10 patients (87% sensitivity, 90% specificity). Intra-abdominal abscesses were correctly detected in 9/9 patients and excluded in 22/24 patients (100% sensitivity, 92% specificity). Conclusions-In experienced hands TABS is an accurate method for the detection of intestinal complications in Crohn's disease. TABS is thus recommended as a primary investigative method for evaluation of severe Crohn's disease. (Gut 1999;44:112-117)

SICUS and CEUS imaging in Crohn’s disease: an update

“…Within the last two decades, among the cross-sectional imaging techniques, the US has had a growing role in the development and application of techniques for the diagnosis of gastrointestinal diseases, such as appendicitis, diverticulitis and inflammatory bowel diseases (IBD) [12]. Today, bowel US is currently accepted as a clinically important first-line imaging technique in both patients with suspected CD and in follow-up patients known to have CD [13][14][15][16][17][18][19]. Furthermore, the introduction of oral contrast has improved the image quality, overall sensitivity and diagnostic accuracy in the detection of small bowel lesions in CD patients [20], and thus contrast-enhanced ultrasound (CEUS) has become an important imaging modality in patients with CD for grading of disease activity, differentiation between small bowel stricture due to inflammation or mural fibrosis, and the assessment of the response to specific therapy [21,22].…”

Surgery and diagnostic imaging in abdominal Crohn’s disease

“…Gasche et al [47] found that the examination correctly identified the presence of fistulas in 20/23 patients and correctly excluded such lesions in 9/10 (sensitivity 87 %, specificity 90 %). Similar performance was observed in the identification of intra-abdominal abscesses, which were correctly detected in 9/9 patients and correctly excluded in 22/24 (sensitivity 100 %, specificity 92 %).…”

“…An interesting study by Gasche et al [47] evaluated the ability of ultrasound to identify intra-abdominal strictures in Crohn's disease patients scheduled for surgery. Using intra-operative findings as the reference standard, the authors found that ultrasound correctly identified all 22 of the patients with strictures and correctly excluded the presence of these lesions in 10 of 11 cases (sensitivity 100 %, specificity 91 %).…”

Ultrasonographic findings in Crohn’s disease

“…Abdominal complications and extraintestinal features US also allows the identification of extraintestinal features that may be associated with active CD, such as mesenteric fat hypertrophy, the presence of regional enlarged lymph nodes and intraperitoneal free fluid accumulation [32,33]. Since US can find both intraluminal and extraintestinal pathological features, it is a valuable tool for the detection of complications such as stenosis, fistulas and abscesses.…”