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

Watanya Jaidee; Wanwarang Teerasamit; Piyaporn Apisarnthanarak; Napaporn Kongkaewpaisan; Sirinya Panya; Rathachai Kaewlai

doi:10.1016/j.heliyon.2023.e17543

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

Heliyon. 2023 Jun 27;9(7):e17543. doi: 10.1016/j.heliyon.2023.e17543. eCollection 2023 Jul.

Authors

Watanya Jaidee¹, Wanwarang Teerasamit¹, Piyaporn Apisarnthanarak¹, Napaporn Kongkaewpaisan², Sirinya Panya³, Rathachai Kaewlai¹

Affiliations

¹ Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
² Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³ Department of Surgery, Faculty of Medicine Burapha University, Chonburi, Thailand.

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.

Keywords: Bowel necrosis; Humans; Tomography; X-Ray computed.