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Cited by 5Abdominal vascular conditions and treatmentsIntestinal and Peritoneal AdhesionsAppendicitis Diagnosis and Management

Small bowel transmural necrosis secondary to acute mesenteric ischemia and strangulated obstruction: CT findings of 49 patients

Open access
Jaidee, Watanya, Teerasamit, Wanwarang, Apisarnthanarak, Piyaporn, Kongkaewpaisan, Napaporn, Panya, Sirinya, Kaewlai, Rathachai·2023·Heliyon
DOI 10.1016/j.heliyon.2023.e17543PMC PMC10372211
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Abstract

Rationale and objectives: Transmural bowel necrosis (TBN) is an uncommon surgical emergency that represents an endpoint of occlusive acute mesenteric ischemia (AMI), nonocclusive AMI and small bowel obstruction (SBO). According to limited evidence, each etiology of TBN might demonstrate a different CT finding. This investigation aimed to 1) identify overall CT findings of TBN, and 2) compare CT findings of TBN in each etiology. Materials and methods: Forty-nine consecutive adults (mean age, 64.6 years; 26 men) with occlusive AMI, nonocclusive AMI or SBO, and pathologically proven TBN were enrolled. All had a CT scan within 24 h before surgery. Clinical information was compiled from medical records. CT examinations were re-reviewed by two radiologists with disagreements resolved by the third radiologist. Data were analyzed and compared. Results: Transmural bowel necrosis were secondary to arterial AMI, venous AMI, combined arterial and venous AMI, nonocclusive AMI, and SBO in 6, 5, 2, 10, and 26 patients, respectively. The CT findings were ascites (93.9%), abnormal wall enhancement (91.8%), bowel dilatation (89.8%), mesenteric fat stranding (89.8%), abnormal wall thickness (71.5%), pneumatosis (46.9%) and intrinsic hyperattenuation of bowel walls (22.5%). Portovenous gas, mesenteric venous gas, and pneumoperitoneum were present in 4 patients (8.2%). Bowel wall thickness was the only CT findings that showed a statistically significant difference among the 5 etiologies of TBN (P = 0.046). Conclusions: Most common CT findings of TBN were ascites, abnormal bowel wall enhancement, dilatation, and mesenteric fat stranding. Wall thickness differentiated five etiologies, being most thickened in venous AMI and normal in arterial AMI.

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Crossref · 10.1016/j.heliyon.2023.e17543

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  • CT radiographic factors for acute mesenteric ischemia include bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilatation, pneumatosis intestinalis, portal mesenteric venous gas, and arterial occlusive acute mesenteric ischemia.

    “These include bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilatation, pneumatosis intestinalis, portal mesenteric venous gas, and arterial occlusive acute mesenteric ischemia [28,29].”

    From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [29]

    The Results > CT features section (page not specified) reports wall thinning, decreased enhancement, dilatation, pneumatosis, and portal or mesenteric venous gas on CT. However, these findings are reported for patients with transmural bowel necrosis, not acute mesenteric ischemia generally. The Abstract > Results identifies arterial AMI as a cause of necrosis, not as a CT finding. (LLM, conf=0.86)

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  • Bowel wall thickening, portovenous gas, and mesenteric venous gas are highly specific for diagnosing transmural intestinal necrosis.

    “Bowel wall thickening, portovenous gas, and mesenteric venous gas are highly specific for diagnosing transmural intestinal necrosis [28,29].”

    From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [29]

    The Results > CT features section reports bowel wall thickening in 26 of 49 patients with transmural bowel necrosis and portal and mesenteric venous gas in 4 patients each. These findings establish that the signs occurred in affected patients, but the paper does not establish that they are highly specific for diagnosing necrosis; its reported comparisons are among causes of necrosis, not against patients without it. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • Decreased or absent bowel wall enhancement and dilatation can be predictors of transmural intestinal necrosis in venous occlusive acute mesenteric ischemia.

    “Decreased or absent bowel wall enhancement and dilatation can be predictors of transmural intestinal necrosis in venous occlusive acute mesenteric ischemia [28,29].”

    From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [29]

    The Results (CT features; page not available) report decreased bowel-wall enhancement and dilatation as frequent findings among 49 patients with transmural bowel necrosis, including five with venous acute mesenteric ischemia. The paper does not establish that these findings predict necrosis specifically in venous occlusive cases; its comparison by etiology identifies bowel-wall thickness, not enhancement or dilatation, as the only significantly differing CT finding. (LLM, conf=0.87)

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Research works printed but not linked: 1

  1. [2]Campbell E.A. Silberman M. Bowel Necrosis. StatPearls. Treasure Island (FL): StatPearls PublishingCopyright © 2022 2022 StatPearls Publishing LLC. 30485003

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Authors
Jaidee, W., Teerasamit, W., Apisarnthanarak, P., Kongkaewpaisan, N., Panya, S., & Kaewlai, R.
Affiliations
  • Siriraj Hospital (TH)
  • Burapha University (TH)
Corresponding author
Kaewlai, Rathachai
ORCID
Venue
Heliyon
Publisher
Elsevier BV
Published
2023-07
Volume
9
Issue
7
Pages
e17543
ISSN
2405-8440 (ISSN-L)
DOI
10.1016/j.heliyon.2023.e17543
PMC
PMC10372211
OpenAlex
W4382044960
Cited by
5
References
34
Citations by year
2026: 2 · 2025: 2 · 2024: 1
FWCI
1.33
Type
journal article
Language
en
Open access
Licence
Locations
  • Heliyon (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Department of Radiology, Weill Cornell Medical College
  • Faculty of Medicine Siriraj Hospital, Mahidol University
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
  • Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
Keywords
acute mesenteric ischemia, nonocclusive mesenteric ischemia, small bowel obstruction, computed tomography findings, bowel wall thickness, pneumatosis, mesenteric fat stranding, ascites

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