Objective: Our purpose was to compare clinical outcomes in patients with acute abdominal pain and inner-layer enhancement of a thickened small-bowel wall, as shown on CT, with outcomes in similar patients without such enhancement.
Materials and methods: We retrospectively studied outcomes in 126 patients with acute abdominal pain and small-bowel wall thickening on CT: 84 with inner-layer enhancement and 42 without this enhancement. We compared the surgical, small-bowel resection, small-bowel necrosis, and mortality rates between the two groups using the chi-square test.
Results: Among the 42 patients without inner-layer enhancement, 32 (76%) underwent an operation, 27 (64%) received segmental small-bowel resection, 26 (62%) had small-bowel necrosis, and seven (17%) died. All of these proportions were significantly higher (p < 0.01) than the corresponding rates-34 (40%), nine (11%), five (6%), and two (2%), respectively-in the 84 patients with inner-layer enhancement. All 31 patients with necrotic small bowel had pathologic evidence of ischemic necrosis involving the mucosa.
Conclusion: Among patients with acute abdominal pain, those whose CT scans did not show inner-layer enhancement of a thickened small-bowel wall were more prone to undergo surgery and small-bowel resection and were more likely to have small-bowel necrosis than those with such enhancement. Poor inner-layer enhancement on CT might be consistent with sloughed or necrotic mucosa, as observed on pathology.