• bowel wall thickening
• ct imaging
• diagnostic accuracy
• inflammatory bowel disease
• neoplastic lesions
• small bowel

• Contrast-enhanced ultrasonography
• Diagnosis
• Strangulated ileus
• Ultrasonography
• operation

• canine
• gastric wall thickening
• hypoalbuminemia
• submucosal edema

• Computed tomography
• Intestines
• Ischemia
• Small bowel

• Age
• Carcinoma
• Computed tomography
• Diverticular disease
• Haemoglobin
• Mural thickening
• Polyp

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Biomarkers/metabolism
• Diagnosis, Differential
• Endoscopy, Digestive System
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Neoplasms/complications
• Gastrointestinal Neoplasms/diagnosis
• Gastrointestinal Neoplasms/metabolism
• Hemoglobins/metabolism
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Tomography, X-Ray Computed

To improve the identification and computed tomography (CT) diagnostic accuracy of chronic active Epstein-Barr virus (EBV)-associated enteritis (CAEAE) by evaluating its CT findings and clinical manifestation.

The data of three patients with pathologically and clinically confirmed CAEAE who underwent CT enterography (CTE) were retrospectively reviewed from January 2018 to October 2019. The following data were evaluated: imaging characteristics (length of involvement, pattern of mural thickening, pattern of attenuation, perienteric abnormalities), clinical symptoms, endoscopic records, laboratory examinations, and pathologic findings.

Based on CT findings, two patients demonstrated segmental bowel wall thickening (involvement length >6 cm), asymmetric thickening, layered attenuation, fat stranding, and adenopathy, whereas the remaining one had no positive finding. The endoscopic results of all patients showed numerous irregular ulcers in the colon, and one patient had a focal esophageal ulcer. The major clinical symptoms were abdominal pain (n = 3), retrosternal pain (n = 1), fever (n = 3), diarrhea (n = 2), hematochezia (n = 1), and adenopathy (n = 3). The main laboratory examination indicators were increased serum EBV DNA load (n = 1) and increased inflammatory markers (n = 3). With regard to the main pathologic findings, all patients showed positive EBV-encoded RNA (EBER) situ hybridization in the colonic biopsy specimen, with one patient being positive in the esophagus.

CAEAE is rare and is usually misdiagnosed as inflammatory bowel disease (IBD). The imaging features of CAEAE overlap with those of Crohn's disease and ulcerative colitis. The presence of segmental and asymmetric bowel wall thickening, layered attenuation, and fat stranding in the CTE image may be helpful in differentiating CAEAE from IBD.

• Asymmetry of lesion
• Focal/segmental bowel involvement
• Heterogeneous enhancement
• Marked bowel wall thickening

Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography (CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.

• Small bowel obstruction
• Internal hernias
• Transomental hernia
• Multi-detector row computed tomography
• Strangulation

In this article we present a simplified algorithm-based approach to the thickening of the small and large bowel wall detected on routine computed tomography (CT) of the abdomen.

Thickening of the small or large bowel wall may be caused by neoplastic, inflammatory, infectious, or ischaemic conditions. First, distinction should be made between focal and segmental or diffuse wall thickening. In cases of focal thickening further analysis of the wall symmetry and perienteric anomalies allows distinguishing between neoplasms and inflammatory conditions. In cases of segmental or diffuse thickening, the pattern of attenuation in light of clinical findings helps narrowing the differential diagnosis.

Focal bowel wall thickening may be caused by tumours or inflammatory conditions. Bowel tumours may appear as either regular and symmetric or irregular or asymmetric thickening. When fat stranding is disproportionately more severe than the degree of wall thickening, inflammatory conditions are more likely. With the exception of lymphoma, segmental or diffuse wall thickening is usually caused by benign conditions, such as ischaemic, infectious and inflammatory diseases.

• Thickening of the bowel wall may be focal (<5 cm) and segmental or diffuse (6-40 cm or >40 cm) in extension.

• Focal, irregular and asymmetrical thickening of the bowel wall suggests a malignancy.

• Perienteric fat stranding disproportionally more severe than the degree of wall thickening suggests an inflammatory condition.

• Regular, symmetric and homogeneous wall thickening is more frequently due to benign conditions, but can also be caused by neoplasms such as well-differentiated adenocarcinoma and lymphoma.

• Segmental or diffuse bowel wall thickening is usually caused by ischaemic, inflammatory or infectious conditions and the attenuation pattern is helpful in narrowing the differential diagnosis.

The purpose of this study was to examine the impact on emergency department (ED) length of stay (LOS) of a new protocol for intravenous (IV)-contrast only abdominal/pelvic computed tomography (ABCT) compared to historical controls.

This was a retrospective case-controlled study performed at a single academic medical center. Patients ≥ 18 undergoing ABCT imaging for non-traumatic abdominal pain were included in the study. We compared ED LOS between historical controls undergoing ABCT imaging with PO/IV contrast and study patients undergoing an IV-contrast-only protocol. Imaging indications were the same for both groups and included patients with clinical suspicion for appendicitis, diverticulitis, small bowel obstruction, or perforation. We identified all patients from the hospital’s electronic storehouse (imaging code, ordering department, imaging times), and we abstracted ED LOS and disposition from electronic medical records.

Two hundred and eleven patients who underwent PO/IV ABCT prep were compared to 184 patients undergoing IV-contrast only ABCT prep. ED LOS was shorter for patients imaged with the IV-contrast only protocol (4:35 hrs vs. 6:39 hrs, p < 0.0001).

Implementation of an IV-contrast only ABCT prep for select ED patients presenting for evaluation of acute abdominal pain significantly decreased ED LOS.

• CT
• Independent finding
• Life-threatening mesenteric occlusion
• Superior mesenteric artery thromboembolism
• Superior mesenteric vein thrombosis

AIM: To clarify the usefulness of arterial phase scans in contrast computed tomography (CT) imaging of strangulation ileus in order to make an early diagnosis.

METHODS: A comparative examination was carried out with respect to the CT value of the intestinal tract wall in each scanning phase, the CT value of the content in the intestinal tract, and the CT value of ascites fluid in the portal vein phase for a group in which ischemia was observed (Group I) and a group in which ischemia was not observed (Group N) based on the pathological findings or intra-surgical findings. Moreover, a comparative examination was carried out in Group I subjects for each scanning phase with respect to average differences in the CT values of the intestinal tract wall where ischemia was suspected and in the intestinal tract wall in non-ischemic areas.

RESULTS: There were 15 subjects in Group I and 30 subjects in Group N. The CT value of the intestinal tract wall was 41.8 ± 11.2 Hounsfield Unit (HU) in Group I and 69.6 ± 18.4 HU in Group N in the arterial phase, with the CT value of the ischemic bowel wall being significantly lower in Group I. In the portal vein phase, the CT value of the ischemic bowel wall was 60.6 ± 14.6 HU in Group I and 80.7 ± 17.7 HU in Group N, with the CT value of the ischemic bowel wall being significantly lower in Group I; however, no significant differences were observed in the equilibrium phase. The CT value of the solution in the intestine was 18.6 ± 9.5 HU in Group I and 10.4 ± 5.1 HU in Group N, being significantly higher in Group I. No significant differences were observed in the CT value of the accumulation of ascites fluid. The average difference in the CT values between the ischemic bowel wall and the non-ischemic bowel wall for each subject in Group I was 33.7 ± 20.1 HU in the arterial phase, being significantly larger compared to the other two phases.

CONCLUSION: This is a retrospective study using a small number of subjects; however, it suggests that there is a possibility that CT scanning in the arterial phase is useful for the early diagnosis of strangulation ileus.

• Arterial phase
• Strangulation ileus
• Small bowel obstruction
• Computed tomography
• Retrospective study

• Adult
• Aged
• Capsule Endoscopy/methods
• Contrast Media
• Female
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/pathology
• Humans
• Intestinal Diseases/diagnostic imaging
• Intestinal Diseases/pathology
• Intestinal Neoplasms/diagnostic imaging
• Intestinal Neoplasms/pathology
• Intestine, Small/diagnostic imaging
• Intestine, Small/pathology
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged
• Multidetector Computed Tomography/adverse effects
• Multidetector Computed Tomography/methods
• Radiation Effects
• Radiographic Image Enhancement/methods
• Risk Assessment
• Sensitivity and Specificity
• Tomography, X-Ray Computed/adverse effects
• Tomography, X-Ray Computed/methods

• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Contrast Media/administration & dosage
• Diagnosis, Differential
• Female
• Humans
• Intestinal Diseases/diagnostic imaging
• Intestine, Small/diagnostic imaging
• Male
• Middle Aged
• Tomography, X-Ray Computed/methods

• Abdomen, Acute/diagnostic imaging
• Abdomen, Acute/etiology
• Adult
• Aged
• Aged, 80 and over
• Colon/blood supply
• Colon/pathology
• Contrast Media
• Diagnosis, Differential
• Female
• Humans
• Infarction/complications
• Infarction/diagnostic imaging
• Ischemia/complications
• Ischemia/diagnostic imaging
• Male
• Middle Aged
• Retrospective Studies
• Tomography, X-Ray Computed/methods