Abstract

HUETE G, Alvaro; VILLANUEVA A, Eduardo  and  MENESES Q, Luis. GANGRENOUS NON OCCLUSIVE ISCHEMIC COLITIS: DIAGNOSTIC CRITERIA WITH MULTIDETECTOR COMPUTED AXIAL TOMOGRAPHY (MDCT). Rev. chil. radiol. [online]. 2007, vol.13, n.4, pp.197-202. ISSN 0717-9308.  http://dx.doi.org/10.4067/S0717-93082007000400005.

: Introduction: Ischemia constitutes the major cause of colitis in patients over the age of 50. The vast majority of cases are a self-limited with good prognosis. There is a sub-group of patients which develop transmural ischemia leading to parietal necrosis, perforation and peritonitis, with secundan/ sepsis-related mortality. ObjectiveJo record luminal, parietal and peritoneal findings in patients with colonic necrosis ofischemic ethiology so as to provide a timely diagnosis. Material and Methods: In a retrospective study, both medical records and imaging studies of 12 patiens (7 male, 5 female), ranging from 46 to 91 years of age (mean age: 70.3 years) with necrosis secondary to nonocclusive ischemic colitis (IC) were revised. Patient's status (out-patient, in-patient) as well as risk factors and symptoms were documented. All patients underwent Multidetector Row Computed Axial Tomography (MDCT). Results: Six patients presented to the emergency unit because of abdominal pain and six patients developed symptoms during hospitalization for other causes. Parietal assessment showed absence of contrast enhancement in 11 cases out of 12 (91.6 %), and mural or vascular pneumatosis in 5 cases (41.6 %). Wall thickening was seen in 4 patients (33%), and pericolonic gas was found in 3 cases (25 %). If we consider both ileus and pericolonic inflamatory changes as nonspecific findings, the absence of colon mural enhancement was the only marker of severe parietal injury in 3 patients (25%). Conclusion: Classical signs of IC -such as wall thickening- are unlikely to be found in advanced cases presenting mural gangrene. Lack of post-contrast parietal enhancement is a finding that correlates with presence of necrosis, and maybe the only tomographic marker of irreversible transmural ischemic lesion of the colon

Keywords : Colonic necrosis; Ischemic colitis; Non occlusive ischemia; Multidetector row computed tomography.