Computed tomography in the diagnosis of portal venous and intestinal wall gas in patients with ischemic bowel disease

Abstract

Objective To investigate radiological features on computed tomography (CT) in the diagnosis of portal venous and intestinal wall gas in patients with ischemic bowel disease. Methods The clinic-pathological data of 17 patients with portal venous and intestinal gas associated with ischemic bowel diseases from Wenzhou People's Hospital (n=6), Yueqing People's Hospital (n=5), Shanghai Xuhui Dahua Hospital (n=3) and the Second Affiliated Hospital of Wenzhou Medical University (n=3) from January 2013 to October 2016 were analysed retrospectively. All the patients have been fasting for 8 h prior to CT scans. Enhanced CT study was performed following routine CT with no abdominal pressure for breathless scanting. Portal venous gas, intestinal wall gas, intestinal thickness and density, mesentery thickness, celiac effusion, and severity of intestinal wall enhancement were recorded. Results All the 17 patients experienced abdominal distension and pain. Additionally, nausea and vomiting was observed in 9 patients, diarrhea in 7, melena in 7, periumbilical tenderness in 11 and rebound tenderness in 8. CT scans of these 17 patients showed portal venous gas, including massive prune-tree signs of hepatic vein and portal vein (n=11) and scanty gas shadows in distal hepatic vein (n=6). Intestinal gas sign was determined in all these patients (n=17), including single shadow (n=8), multiple shadow (n=7), and band-shaped bubble (n=2). Furthermore, CT study indicated extensive intestinal wall thickening with edema (n=13), predominate luminal extension of thinner bowels (n=4), scanty celiac effusion (n=3). Enhanced CT scans demonstrated 8 patients with decreased enhancement of intestinal wall and mesentery with diseases, target and halo signs observed in enhanced scans. Conclusions Portal venous and intestinal wall gas may demonstrate distinctive CT imaging. CT study could have superior sensitivity and specialty in clinical diagnoses of ischemic bowel diseases. Key words: Portal venous gas; Intestinal wall gas; Ischemic bowel disease; Tomography, X-ray computer