Acute bowel ischemia: analysis of diagnostic error by overlooked findings at MDCT angiography
Abstract
To retrospectively evaluate the frequency and type of findings that were missed in the original reports of multi-detector CT angiography (MDCTA) in patients with suspected acute bowel ischemia. From January 2007 to March 2011, a series of 35 patients who underwent MDCTA of the abdomen and pelvis and had surgery were included. The reports of the initial CT were retrospectively compared with the discharge diagnosis and surgical reports. Discrepant or missing findings were re-evaluated and divided into relevant or not relevant regarding the diagnosis. In 23 of the 35 patients (66 %), all findings were correctly diagnosed in the initial MDCTA report. In the remaining 12 of the 35 patients (34 %), lesions that were not reported were present at surgery. In 10 of the 12 (83 %) patients, the overlooked findings were relevant and subtle: gas in the portal vein (n = 3), gas in the bowel wall (n = 3), gas in the portal vein and bowel wall (n = 2), thrombotic occlusion of the superior mesenteric artery (n = 1), and thrombotic occlusion of the inferior mesenteric artery (n = 1). In 2 of the 12 (17 %) patients in whom the MDCTA-overlooked findings were classified as non-relevant, bowel ischemia was found at surgery. With retrospective image interpretation, 83 % of the patients with occlusive mesenteric ischemia at surgery were correctly identified, whereas the remaining 17 % with non-occlusive mesenteric ischemia at surgery showed non-relevant findings at MDCTA. About 33 % of relevant findings of bowel ischemia were overlooked by the initial MDCTA interpretation, most were subtle findings. However, secondary reading revealed most of these findings and can serve to improve diagnostic performance.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Re-assessment of imaging may detect overlooked radiological findings associated with AMI not reported at the initial reading, especially if the imaging protocol is not optimal.
“It is not unusual that a re-assessment of the imaging may detect overlooked radiological findings associated with AMI not reported at the initial reading, especially if the imaging protocol is not optimal. 143,144”
Cites
Measurement of Observer Agreement
Kundel, H. L., & Polansky, M. (2003) · Radiology · doi:10.1148/radiol.2282011860 · Cited by 1,486 · see citing works
Pneumatosis intestinalis: a review.
Pear, B. L. (1998) · Radiology · doi:10.1148/radiology.207.1.9530294 · Cited by 545 · see citing works
Wiesner, W., Khurana, B., Ji, H., & Ros, P. R. (2003) · Radiology · doi:10.1148/radiol.2263011540 · Cited by 402 · see citing works
Pneumatosis Intestinalis in the Adult: Benign to Life-Threatening Causes
Ho, L. M., Paulson, E. K., & Thompson, W. M. (2007) · American Journal of Roentgenology · doi:10.2214/ajr.06.1309 · Cited by 396 · see citing works
Kirkpatrick, I. D. C., Kroeker, M. A., & Greenberg, H. M. (2003) · Radiology · doi:10.1148/radiol.2291020991 · Cited by 365 · see citing works
Pneumatosis Intestinalis and Portomesenteric Venous Gas in Intestinal Ischemia
Wiesner, W., Mortelé, K. J., Glickman, J. N., Ji, H., & Ros, P. R. (2001) · American Journal of Roentgenology · doi:10.2214/ajr.177.6.1771319 · Cited by 328 · see citing works
Acute mesenteric ischemia: diagnosis with contrast-enhanced CT.
Taourel, P., Deneuville, M., Pradel, J., Régent, D., & Bruel, J. M. (1996) · Radiology · doi:10.1148/radiology.199.3.8637978 · Cited by 300 · see citing works
Portomesenteric Vein Gas: Pathologic Mechanisms, CT Findings, and Prognosis
Sebastià, C., Quiroga, S., Espín, E., Boyé, R., Álvarez-Castells, A., & Armengol, M. (2000) · Radiographics · doi:10.1148/radiographics.20.5.g00se011213 · Cited by 294 · see citing works
CT and MR Imaging Findings of Bowel Ischemia from Various Primary Causes
Rha, S. E., Ha, H. K., Lee, S., Kim, J. H., Kim, J. K., Kim, J. H., Kim, P. N., Lee, M.-G., & Auh, Y. H. (2000) · Radiographics · doi:10.1148/radiographics.20.1.g00ja0629 · Cited by 278 · see citing works
Radiologic Features of Vasculitis Involving the Gastrointestinal Tract
Ha, H. K., Lee, S. H., Rha, S. E., Kim, J.-H., Byun, J. Y., Lim, H. K., Chung, J. W., Kim, J. K., Kim, P. N., Lee, M.-W., et al. (2000) · Radiographics · doi:10.1148/radiographics.20.3.g00mc02779 · Cited by 214 · see citing works
Mesenteric Venous Thrombosis: Diagnosis and Noninvasive Imaging
Bradbury, M. S., Kavanagh, P. V., Bechtold, R. E., Chen, M. Y., Ott, D. J., Regan, J. D., & Weber, T. M. (2002) · Radiographics · doi:10.1148/radiographics.22.3.g02ma10527 · Cited by 211 · see citing works
Sheedy, S. P., Earnest, F., Fletcher, J. G., Fidler, J. L., & Hoskin, T. L. (2006) · Radiology · doi:10.1148/radiol.2413050965 · Cited by 190 · see citing works
Algorithmic Approach to CT Diagnosis of the Abnormal Bowel Wall
WITTENBERG, J., Harisinghani, M. G., Jhaveri, K. S., Varghese, J. C., & Müeller, P. R. (2002) · Radiographics · doi:10.1148/radiographics.22.5.g02se201093 · Cited by 177 · see citing works
Balthazar, E. J., LIEBESKIND, M., & Macari, M. (1997) · Radiology · doi:10.1148/radiology.205.2.9356638 · Cited by 175 · see citing works
Multi–Detector Row CT of Mesenteric Ischemia: Can It Be Done?
Horton, K. M., & Fishman, E. K. (2001) · Radiographics · doi:10.1148/radiographics.21.6.g01nv091463 · Cited by 154 · see citing works
Kernagis, L. Y., Levine, M. S., & Jacobs, J. E. (2003) · American Journal of Roentgenology · doi:10.2214/ajr.180.3.1800733 · Cited by 152 · see citing works
Clinical significance of pneumatosis of the bowel wall.
Feczko, P. J., Mezwa, D. G., Farah, M. C., & White, B. D. (1992) · Radiographics · doi:10.1148/radiographics.12.6.1439012 · Cited by 103 · see citing works
Multidetector row computed tomography findings from ischemia to infarction of the large bowel
Romano, S., Romano, L., & Grassi, R. (2006) · European Journal of Radiology · doi:10.1016/j.ejrad.2006.11.002 · Cited by 91 · see citing works
Intestinal Ischemia Versus Intramural Hemorrhage: CT Evaluation
Macari, M., Chandarana, H., Balthazar, E. J., & Babb, J. S. (2003) · American Journal of Roentgenology · doi:10.2214/ajr.180.1.1800177 · Cited by 73 · see citing works
Jang, K. M., Min, K., Kim, M. J., Koh, S. H., Jeon, E. Y., Kim, I., & Choi, D. (2010) · American Journal of Roentgenology · doi:10.2214/ajr.09.2702 · Cited by 65 · see citing works
Blachar, A., Barnes, S., Adam, S. Z., Levy, G., Weinstein, I., Precel, R., Federle, M. P., & Sosna, J. (2011) · Emergency Radiology · doi:10.1007/s10140-011-0965-4 · Cited by 51 · see citing works
Multidetector CT imaging in mesenteric ischemia—pearls and pitfalls
Wasnik, A. P., Kaza, R. K., Al-Hawary, M. M., Liu, P. S., & Platt, J. F. (2010) · Emergency Radiology · doi:10.1007/s10140-010-0921-8 · Cited by 50 · see citing works
Intestinal pneumatosis in adults: diagnostic and prognostic value
Lassandro, F., Stefano, M. L. M. D. S., Porto, A. M., Grassi, R., Scaglione, M., & Rotondò, A. (2010) · Emergency Radiology · doi:10.1007/s10140-010-0868-9 · Cited by 42 · see citing works
A Radiological Approach to the Patient with Acute, Extensive Bowel lschemia
WITTENBERG, J., Athanasoulis, C. A., Shapiro, J. H., & Williams, L. F. (1973) · Radiology · doi:10.1148/106.1.13 · Cited by 41 · see citing works
Prognostic value of multidetector computed tomography in bowel infarction
Moschetta, M., Ianora, A. A. S., Pedote, P., Scardapane, A., & Angelelli, G. (2009) · La radiologia medica · doi:10.1007/s11547-009-0422-6 · Cited by 38 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Editor's Choice – Management of the Diseases of Mesenteric Arteries and Veins
Björck, M., Koelemay, M., Acosta, S., Bastos Goncalves, F., Kölbel, T., Kolkman, J. J., Lees, T., Lefevre, J. H., Menyhei, G., Oderich, G., et al. (2017) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2017.01.010 · Cited by 658 · see citing works
Computed Tomography: Revolutionizing the Practice of Medicine for 40 Years
Rubin, G. D. (2014) · Radiology · doi:10.1148/radiol.14141356 · Cited by 197 · see citing works
Acute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly
Kärkkäinen, J. M., Lehtimäki, T. T., Manninen, H., & Paajanen, H. (2015) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-015-2830-3 · Cited by 150 · see citing works
Newman‐Toker, D. E., Wang, Z., Zhu, Y., Nassery, N., Tehrani, A. S. S., Schaffer, A. C., Yu-Moe, C. W., Clemens, G. D., Fanai, M., & Siegal, D. (2020) · Diagnosis · doi:10.1515/dx-2019-0104 · Cited by 159 · see citing works
Recent advances in near-infrared fluorescence-guided imaging surgery using indocyanine green
Namikawa, T., Sato, T., & Hanazaki, K. (2015) · Surgery Today · doi:10.1007/s00595-015-1158-7 · Cited by 110 · see citing works
Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123 · see citing works
Lehtimäki, T. T., Kärkkäinen, J. M., Saari, P., Manninen, H., Paajanen, H., & Vanninen, R. (2015) · European Journal of Radiology · doi:10.1016/j.ejrad.2015.09.006 · Cited by 104 · see citing works
Three-dimensional MDCT angiography of splanchnic arteries: Pearls and pitfalls
Dohan, A. J. J., Dautry, R., Guerrache, Y., Fargeaudou, Y., Boudiaf, M., Dref, O. L., Sirol, M., & Soyer, P. A. (2014) · Diagnostic and Interventional Imaging · doi:10.1016/j.diii.2014.06.011 · Cited by 41 · see citing works
Principles and Applications of Dual-Layer Spectral CT in Gastrointestinal Imaging
Franco, P. N., Spasiano, C. M., Maino, C., Ponti, E. D., Ragusi, M., Giandola, T. P., Terrani, S., Peroni, M., Corso, R., & Ippolito, D. (2023) · Diagnostics · doi:10.3390/diagnostics13101740 · Cited by 31 · see citing works
Torres, U. S., Fortes, C. D. F. M., Salvadori, P. S., Tiferes, D. A., & D’Ippolito, G. (2017) · Seminars in Ultrasound CT and MRI · doi:10.1053/j.sult.2017.09.002 · Cited by 26 · see citing works
Matsumoto, S., Shiraishi, A., Kojima, M., Funaoka, H., Funabiki, T., Saida, T., & Kitano, M. (2018) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000002100 · Cited by 21 · see citing works
Oda, S., Nakaura, T., Utsunomiya, D., Funama, Y., Taguchi, N., Imuta, M., Nagayama, Y., & Yamashita, Y. (2017) · Emergency Radiology · doi:10.1007/s10140-017-1511-9 · Cited by 20 · see citing works
Evaluating for acute mesenteric ischemia in critically ill patients
Lee, M. J., Sperry, J. L., & Rosengart, M. R. (2014) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000000381 · Cited by 13 · see citing works
Anatomy, Abdomen and Pelvis, Inferior Mesenteric Artery
Skinner, D., & Fossen, K. V. (2018) · StatPearls · Cited by 13 · see citing works
Diagnostic laparoscopy for pneumatosis intestinalis
Karabuğa, T., Yoldaş, Ö., Özsan, İ., Yıldırım, U. M., & Aydin, U. (2014) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2014.04.042 · Cited by 12 · see citing works
Errors in MDCT diagnosis of acute mesenteric ischemia
Pinto, A., Lanzetta, M. M., Addeo, G., Bonini, M. C., Grazzini, G., & Miele, V. (2020) · Abdominal Radiology · doi:10.1007/s00261-020-02732-y · Cited by 8 · see citing works
Appendicitis-related pneumatosis intestinalis and portal venous gas in a pregnant woman
Lemos, A. A., Cioffi, U., Ossola, M. W., & Conte, D. (2014) · Digestive and Liver Disease · doi:10.1016/j.dld.2013.12.020 · Cited by 8 · see citing works
Self-citationSaito, H., Noda, K., Ogasawara, K., Atsuji, S., Takaoka, H., Kajihara, H., Nasu, J., Kitaoka, M., Morishita, S., Matsushita, I., et al. (2018) · Radiology Case Reports · doi:10.1016/j.radcr.2018.01.028 · Cited by 8 · see citing works
Intestinal fatty acid binding protein (I-FABP) as a marker for acute intestinal ischemia
Girish, T. U., & Hegde, A. (2019) · International Surgery Journal · doi:10.18203/2349-2902.isj20190058 · Cited by 4 · see citing works
An Overview of Acute Mesenteric Ischemia
Mirrahimi, A., Gallienne, C., & Ghandehari, H. (2021) · Applied Radiology · doi:10.37549/ar2703 · Cited by 2 · see citing works
The Importance of Predicting Bowel Necrosis in Acute Mesenteric Ischemia: Narrative Review
Giannessi, C., Cozzi, D., Scalzone, L., Treballi, F., Anichini, M., Sessa, B., Ferrarelli, A., Danti, G., & Vittorio, M. (2026) · Diagnostics · doi:10.3390/diagnostics16020332 · Cited by 1 · see citing works
Angioscanner tridimensionnel des artères splanchniques : avantages et limites
Dohan, A. J. J., Dautry, R., Guerrache, Y., Fargeaudou, Y., Boudiaf, M., Dref, O. L., Sirol, M., & Soyer, P. A. (2014) · Journal de radiologie diagnostique et interventionnelle · doi:10.1016/j.jradio.2014.05.006
Dual-Energy CT in Patients with an Acute Abdomen
Yu, H., Bates, . D. B., & Sahani, D. V. (2018) · Springer eBooks · doi:10.1007/978-3-319-70778-5_3
Factors Leading to Missed Injury at Whole-Body CT
Lemos, A. A., & Brambilla, R. (2018) · Radiology · doi:10.1148/radiol.2018182279
Self-citationWhitworth, J., James, R., & Hopkins, J. C. A. (2019) · BMJ Case Reports · doi:10.1136/bcr-2019-230422
Measurement of Superior Mesenteric Artery using Computed Tomography Angiography
Elgyoum, A. M. A., Amer, A. A. M., Abdelmagid, M. M. A., Omer, A., Gasmallah, H. A. Y., & Albagir, S. A. S. (2021) · Scholars Journal of Applied Medical Sciences · doi:10.36347/sjams.2021.v09i06.033
What you don’t see matters: dual-energy CT in emergency radiology
Anichini, M., Sessa, B., Scalzone, L., Badii, C., Ferrarelli, A., Cozzi, D., & Miele, V. (2026) · Japanese Journal of Radiology · doi:10.1007/s11604-026-02069-4
- Authors
- Firetto, M. C., Lemos, A. A., Marini, A., Avesani, E. C., & Biondetti, P. R.
- Affiliations
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- University of Milan (IT)
- Corresponding author
- Lemos, Alessandro A.
- Venue
- Emergency Radiology
- Published
- 2012-10-03
- Volume
- 20
- Issue
- 2
- Pages
- 139-147
- ISSN
- 1070-3004 (ISSN-L)
- 1438-1435
- OpenAlex
- W2150753432
- Cited by
- 27
- References
- 25
- Citations by year
- 2026: 2 · 2025: 1 · 2023: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 3 · 2015: 3 · 2014: 6
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Emergency Radiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Gastrointestinal disorders and treatments
- Keywords
- mesenteric ischemia, diagnostic errors, missed findings, multidetector CT angiography, portal venous gas, superior mesenteric artery thrombosis, intraoperative findings
- MeSH terms
- Abdomen, Acute, Acute Disease, Adult, Aged, Angiography, Contrast Media, Diagnostic Errors, Female, Humans, Intestines, Ischemia, Male, Middle Aged, Retrospective Studies, Tomography, X-Ray Computed
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
