CT Enteroclysis Research Articles

Role of computed tomography enteroclysis in the evaluation of small bowel diseases

Background: Examining small bowel loops within the peritoneal cavity poses significant challenges because of their length and overlapping nature. Aims and Objectives: This study aimed to evaluate the utility of computed tomography enteroclysis (CTE) in diagnosing small intestinal diseases and to understand its clinical application. Materials and Methods: The study was conducted from November 2019 to October 2021 in 30 patients undergoing CTE treatment. The day before treatment, bowel preparation included a low-residue diet, lots of fluids, an overnight fast of 8–12 h, and laxatives. A 16-slice Aquilion Lightning computed tomography (CT) scanner was used in general hospitals, and a 128-slice GE Healthcare helical CT scanner was used in multispecialty hospitals. Results: Among the 30 patients, 20 (66.7%) were male, and 10 (33.3%) were female, predominantly aged between 30 and 60 years old. Positive findings were noted in 23 patients (76.7%), including intestinal tuberculosis, inflammatory bowel disease, small bowel obstruction, and neoplastic lesions. Various small intestinal pathologies, such as non-specific edema, intussusception, and ischemic bowel disease, were also identified. Conclusion: This raises the standard of current small bowel imaging by delivering suitable intestinal distension using the enteral volume challenge principle and helps identify and characterize small-bowel problems.

Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile

BackgroundSmall bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. AimTo describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. MethodsRetrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. ResultsA total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1–99.2), 82.2% (95%CI: 57.6–93.3), 40.0% (95%CI: 16.5–82.8) and 25.9% (95%CI: 4.5–55.7%), respectively. NET (HR 6.1; 95%CI: 2.1–17.2) and GIST (HR 24.4; 95%CI: 3.0–19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. ConclusionsMalignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.

Circumportal Pancreas - A Rare Case

Circumportal pancreas is a rare anatomical variant in which anomalous pancreatic parenchyma entirely encircles the portal vein. A 60 years old female presented to us for CT enteroclysis with complaint of diffuse abdominal pain. Infrasplenic circumportal pancreas with anteportal pancreatic duct was reported, which is an incidental finding. It presents a diagnostic challenge for a radiologist because misinterpretation of circumportal pancreas as a pancreatic head mass can have a significant impact on clinical outcomes i.e. postoperative pancreatic fistula and can help surgeon to plan better approach for pancreatectomies.

Case report on a rare cause of small bowel perforation perforated ileal diverticulum.

IntroductionComplications due to small bowel non-Meckel's diverticulosis is an uncommon clinical scenario encountered in clinical practice. A diverticulum in the ileum is rare among the locations of the diverticulum in the small intestine. We describe an unusual case of ileal diverticular perforation presenting as an acute abdomen.Case presentation and managementA 74-year-old male presented with septic shock and localized peritonitis in right lower abdomen. Preoperative imaging and intraoperative findings were consistent with terminal ileal diverticular perforation for which right hemicolectomy was done.ConclusionSmall bowel diverticulosis was usually asymptomatic, though it can rarely present with acute abdominal emergencies. Computed tomogram of the abdomen, Barium meal follow-through, capsule endoscopy, CT enteroclysis can be used to diagnose small bowel diverticulosis. Although the incidence of small bowel diverticulosis is low, small bowel diverticulitis should be included in the differential diagnosis if an inflammatory mass involving the small bowel is demonstrated on CT. Patients with localized and self-limited inflammation without free perforation in imaging can be treated conservatively with parenteral antibiotics and close monitoring approach. Surgical intervention is usually required for complicated acute presentations and those with refractory symptoms. A high index of suspicion of complicated small bowel diverticulosis should be in the clinician's mind when dealing with acute small bowel emergencies especially in elderly patients.

S2395 A Series of Unfortunate Events: A Unique Case of Multiple Small Bowel Malignancies in the Setting of Inflammatory Bowel Disease

Introduction: Crohn’s disease (CD) is known to increase malignancy risk. Both large and small bowel adenocarcinoma and intestinal carcinoid tumors have been reported at increased rates in patients with CD but rarely concurrently. Additionally, there is an association between Non-Hodgkin Lymphoma and CD, however this is attributed to the use of immunosuppressive medications. We present a patient with a history of follicular lymphoma and ileal CD who later developed two separate small bowel malignancies. Case description/methods: The patient is a 63-year-old male with hypertension, chronic kidney disease, pulmonary embolism, and follicular lymphoma. His follicular lymphoma was diagnosed in 2009 by axillary lymph node biopsy after presenting with lower extremity swelling, night sweats, and weight loss. Staging CT scans prior to treatment demonstrated thickening of the ileum. He was treated with chemotherapy for two years and then remained on maintenance therapy. Five years after diagnosis, the patient was evaluated for 20 years of intermittent diarrhea. Endoscopic evaluation revealed CD of his ileum as well as a duodenal nodule. Elevated serum gastrin and chromogranin A levels, a positive octreotide scan, and EUS fine needle aspiration confirmed the nodule as a stage 1 duodenal carcinoid tumor which was subsequently resected. The following year, he developed fatigue and was noted to have iron deficiency anemia. Repeat EGD and colonoscopy was unrevealing thus he had a video capsule study which demonstrated narrowing of his ileum. CT enteroclysis revealed inflammation in his ileum. He underwent a small bowel resection and surgical pathology confirmed intestinal-type moderately differentiated adenocarcinoma of the ileum. Discussion: This case describes a unique course of a patient with follicular lymphoma and CD developing two small bowel malignancies related to underlying CD. While there are reports of CD developing as a treatment related complication of NHL and NHL developing as a treatment related complication of CD, our patient likely had untreated CD at time of his lymphoma diagnosis. This untreated CD likely led to the development of adenocarcinoma and his carcinoid is also likely associated with his CD. While it is rare to develop multiple small bowel malignancies, this case highlights the importance of maintaining a high index of suspicion of symptom changes in CD patients as they may be indicative of treatment specific and/or CD complications which may ultimately change management.

Poor Bowel Preparation in Crohn’s Disease

Question: An elderly man with known penetrating Crohn’s disease presents for routine colonoscopy to assess disease activity. He was in clinical remission on a combination of infliximab with mercaptopurine. A colonoscopy 6 months ago was aborted owing to poor bowel preparation in the sigmoid and transverse colon although it was noted that he had a possible narrowing in the sigmoid colon (Figure A). The patient was adamant that he took the preparation as requested. A computed tomography (CT) colonography, CT enteroclysis and repeat colonoscopy with extended bowel preparation were performed.

Computed Tomography–Assisted Diagnosis of Meckel’s Diverticulum for Adults in Emergency

Diagnosing Meckel’s diverticulum in emergency conditions remains challenging, especially in adult cases for acute abdominal complaints. Here, retrospective analysis of computed tomography (CT) findings in such conditions was performed. Retrospective analysis of fifteen adults (sixteen CT scans) with a final diagnosis of Meckel’s diverticulum who underwent a CT scan for acute abdominal complaints was performed. Nine patients received an intravenous (IV) contrast–enhanced CT scan; four of these were CT enteroclysis with oral contrast (mannitol). The accuracy of CT diagnosis was compared with pathological results. The overall accuracy of CT for diagnosing Meckel’s diverticulum is 56.2% (9/16) in our cohort. The accuracy of non-IV contrast CT and IV contrast CT is 25% (4/16) and 77.8% (7/9). All patients undergoing oral contrast (mannitol)–enhanced CT promptly received correct diagnosis. Meckel’s diverticulum localized mostly to the right quadrant, presenting with spherical/oblong morphology or blind-ended tubular aspects. Meckel’s diverticulum contained liquid and gas-like substances, and sometimes enteroliths. Inflammatory infiltrates were present in 9 cases, one with concomitant appendicitis. Obstruction was observed in 6 patients. CT is valuable for identifying Meckel’s diverticulum, especially in conjunction with contrast imaging and with good bowel preparation. An outpouching, blind-ended digestive structure from the distal small bowel is an alarm signal for Meckel’s diverticulum.

Clinical analysis of 180 cases of primary small intestinal tumor

Objective To improve the knowledge and early diagnostic rate of primary small intestinal tumor. Methods From August 2012 to August 2017, hospitalized patients with pathological diagnosis of primary small intestinal tumor (excluding duodenal neoplasm) from Peking Union Medical College Hospital were retrospectively enrolled. The data of clinical manifestations, laboratory examinations, imaging, endoscopy examination, pathological findings and treatment were collected and analyzed. Results A total of 180 patients with primary small intestinal tumor were enrolled. The common clinical manifestations included abdominal pain (76 cases, 42.2%), gastrointestinal bleeding (64 cases, 35.6%), and abdominal distension (30 cases, 16.7%), and 22 (12.2%) patients had no overt clinical symptoms. The sensitivity of carbohydrate antigen 19-9 (CA19-9) in the diagnosis of small bowel adenocarcinoma was 57.1% (12/21). The diagnostic rates of computed tomography enterodysis (CTE), positron-emission computed tomography (PET)/computed tomography (CT), and abdominopelvic enhanced CT were 96.5% (83/86), 100.0% (29/29), and 91.5% (43/47), respectively. The diagnostic small intestinal tumor patients of barium radiography (14 cases), abdominopelvic magnetic resonance imaging (MRI) (eight cases), small bowel endoscopy (18 cases) and capsule endoscopy (eight cases) were seven, six, fifteen and six cases, respectively. Among 180 patients, 14 (7.8%) patients were considered gynecological tumors by imaging examination before surgery, seven (3.9%) patients underwent emergency operation because of intestinal obstruction, four (2.2%) patients underwent emergency surgery due to gastrointestinal bleeding, and four (2.2%) patients underwent emergency surgery because of intestinal perforation. Histopathological type included gastrointestinal stromal tumor (117 cases, 65.0%), lymphoma (25 cases, 13.9%) and adenocarcinomas (21 cases, 11.7%). Except seven patients with intestinal lymphoma who received chemotherapy, the rest 173 patients underwent surgical resection. Conclusions Primary small bowel tumor has no specific clinical manifestations. It should be alert on patients without positive findings by regular gastroendoscopy and colonendoscopy examination but with symptoms of abdominal pain, gastrointestinal bleeding and intestinal obstruction. CTE should be the first choice for patients with symptoms but unclear diagnosis. Key words: Gastrointestinal stromal tumors; Adenocarcinoma; Lymphoma; Small bowel tumor; Computed tomography enteroclysis; Tumor markers

Tumors of the small bowel: about 27 cases

Les tumeurs gréliques représentent 5% de l'ensemble des tumeurs du tractus digestif. Leur pronostic reste sombre vu le retard diagnostic dû au manque de spécificité des manifestations cliniques et à la difficulté d'exploration bien que d'important progrès ont été fait sur le plan radiologique et endoscopique. Le but de ce travail est de préciser les aspects endoscopiques et histologiques des tumeurs gréliques. Il s’agit d’une étude rétrospective descriptive menée au Service d'Hépato-gastro-entérologie du CHU Hassan II de Fès sur une période de 11 ans (2002-2012). Nous avons analysé les aspects épidémiologiques, cliniques, endoscopiques et histologiques. 27 cas avaient été colligés. L'âge moyen était de 48 ans [21-80ans] avec une prédominance masculine (H/F: 2,4). La tumeur avait été révélée par des mélénas chez 55%, une masse abdominale chez 15% et un syndrome de Koenig ou syndrome occlusif chez 11%. Un antécédent de maladie cœliaque avait été retrouvé dans un cas. L’entéroscanner avait pu préciser le siège de la tumeur chez 18 cas. L’entéroscopie poussée pour les tumeurs proximales et l’entéroscopie double ballonnets pour les tumeurs à localisation distale avaient été réalisées chez 8 patients (30%), l'aspect endoscopique avait révélé une lésion ulcérée chez 37,5%, ulcérée sténosante chez 50% et ulcéro-bourgeonnante sténosante chez 25%. Dans 18 cas, c’est la chirurgie avec étude anatomopathologique de la pièce opératoire qui avait permis de poser le diagnostic. Le type histologique été dominé par les tumeurs stromales 14 cas (51%), suivi des adénocarcinomes 5 cas (18,5%), 4 cas (15%) de LMNH de type B, un cas de carcinome neuroendocrine jéjunal. Les tumeurs gréliques sont rares mais de pronostic sombre, les méthodes actuelles d'imageries (Entéroscanner et Entéro IRM) couplées aux examens endoscopiques, précisément l’entéroscopie double ballonnet, devraient permettre un diagnostic plus précoce et une diminution de la mortalité.

Detection of small-bowel tumours with CT enteroclysis using carbon dioxide and virtual enteroscopy: A preliminary study.

The aim of this prospective study was to evaluate the feasibility, tolerance and performance of virtual enteroscopy (VE) using carbon dioxide for small-bowel distension in patients with suspected small-bowel tumours (SBTs). After IRB approval, 17 patients with suspected SBTs were prospectively included. Radiation dose was compared to 34 matched patients (2 for 1) for age, gender and body weight, who had undergone CT-enteroclysis with neutral contrast (CTE). Performance of VE was evaluated through comparison with the current standard of reference, including surgery and/or enteroscopy and/or follow-up. Tolerance was excellent in 16/17 patients (94%). The radiation dose was lower for VE than for CTE (533 ± 282 vs. 974 ± 505mGy.cm; p = 0.002). With VE, a total of 25 polyps >5mm in size were depicted in 12/17 patients. On a per-lesion analysis, sensitivity and positive predictive value of VE were 92.0% and 92.0%, respectively. On a per-segment analysis VE had a sensitivity and specificity of 95.0% and 87.0%, respectively. Our preliminary study suggests that VE is a feasible and well-tolerated technique with high sensitivity and specificity for the diagnosis of SBT. • Virtual enteroscopy is feasible and well tolerated. • Virtual enteroscopy appears to be accurate for detection of small-bowel tumours. • Sensitivity and PPV of virtual enteroscopy is 92.0% and 92.0%. • Radiation dose is lower with virtual enteroscopy compared to MDCT-enteroclysis.

Progression of diagnosis and treatment in primary malignant small bowel tumor

Primary malignant small bowel tumor as a rare kind of intestinal tumor is associated with a poor prognosis. The pathological types were various and complicated, such as adenocarcinoma, neuroendocrine tumor, malignant lymphoma, and malignant stromal tumor. The atypical early stage symptom resulted in difficult diagnosis at early stage, high misdiagnosis rate and lack of standard therapy schemes and means. In the past, X-ray, CT, MRI, and PET-CT were the main examination methods for primary small bowel tumor. However, with the development of radiology, a series of new diagnosis methods, including electronic enteroscopy, capsule endoscopy, multi-slice spiral CT enteroclysis and so on, promotes the diagnosis accurate rate. Surgery is still the most important method in the small bowel tumor treatment, and the alternative of the surgical method should depend on the tumor location, size and relationship with the adjacent organs. Application of the laparoscopic surgery for the small bowel tumor is still in the initial stage. Besides, some researches have confirmed that chemotherapy, radiotherapy, target therapy and endocrinotherapy have effects on the specific kind of small bowel tumor. Therefore this article will review the epidemiology, pathology, diagnosis and treatment of the primary malignant small bowel tumors.

Pilot study of endoscopic retrograde 3-dimensional – computed tomography enteroclysis for the assessment of Crohn’s disease

PurposeEndoscopic retrograde ileography (ERIG) is developed in our institute and applied clinically for the diagnosis and assessment of the Crohn’s disease activity. We have further improved the technique using 3-dimensional – computed tomography enteroclysis (3D-CTE) and conducted a retrospective study to determine the feasibility and the diagnostic value of endoscopic retrograde 3D-CTE (ER 3D-CTE) in Crohn’s disease patients in a state of remission. MethodsThirteen Crohn’s patients were included in this pilot study. CTE was performed after the infusion of air or CO2 through the balloon tube following conventional colonoscopy. The primary endpoint of this study was to assess the safety of this method. Secondarily, the specific findings of Crohn’s disease and length of the visualized small intestine were assessed. ResultsThe procedures were completed without any adverse events. Gas passed through the small intestine and enterographic images were obtained in 10 out of 13 cases, but, in the remaining patients, insertion of the balloon tubes into the terminal ileum failed. Various features specific to Crohn’s disease were visualized using ER 3D-CTE. A cobble stone appearance or hammock-like malformation was specific and effective for diagnosing Crohn’s disease and the features of anastomosis after the surgical operations were also well described. Therefore, this technique may be useful after surgery. ConclusionIn this study, ER 3D-CTE was performed safely in Crohn’s disease patients and may be used for the diagnosis and follow-up of this disease.

Mesenteric changes in an ultrasound examination can facilitate the diagnosis of neuroendocrine tumors of the small intestine.

Neuroendocrine tumors make up an interesting pathology of a variable clinical picture, prognosis, localization, endocrine activity and degree of malignancy.AimThe aim of this paper is to assess whether ultrasonography can be helpful in diagnosing neuroendocrine tumors in the small intestine by analyzing changes in the mesentery.Material and methodsFrom 1996 to 2013, we encountered 17 patients (9 women and 8 men at the mean age of 57) with a neuroendocrine tumor in the small intestine. The diagnosis was confirmed in all patients by pathomorphological examinations. All retrospectively analyzed patients (n =17) had an abdominal US examination conducted in accordance with the previously mentioned protocol.ResultsPrimary neuroendocrine tumors were visualized ultrasonography in 13 of 17 patients (76.5%). In the remaining 4 patients, tumors in the small bowel were diagnosed in CT enteroclysis (n = 3) and conventional enteroclysis (n = 1). Somatostatin receptor scintigraphy and CT enteroclysis supplemented the ultrasound result by providing information about the stage of the disease in 7 cases. In most of the 17 patients with a neuroendocrine tumor diagnosed by ultrasound (n = 11, 64.7%), changes in the mesentery were prevailing pathological signs that raised suspicion and, consequently, helped localize the primary lesion. The hypoechoic mesenteric lymph nodes were the greatest (9–18 mm), well-circumscribed, and the largest of them showed signs of vascularization. The size of hypoechoic lesions in the mesentery ranged from 25 to 53 mm. These lesions showed moderate blood flow. All of them were single, usually poorly circumscribed; two lesions showed slight calcifications.ConclusionsIn an abdominal US examination, 2/3 of patients with neuroendocrine tumors in the small bowel manifest secondary lesions in the mesentery which are easier to visualize than the primary focus. 30% of them are manifested as hypoechoic masses. The detection of such lesions should prompt the search for the primary focus in the small intestine.

Acute ileo-ileal intussusception due to intestinal metastatic melanoma

Abstract Introduction Although gastrointestinal tract is a fairly frequent site of melanoma metastases, reports of small bowel intussusception caused by melanoma metastasis are very rare. Aim To describe a rare complication of metastatic melanoma and to expose the difficulties to screen digestive metastases of melanoma. Case study We report the case of a 69-year-old woman who was admitted for abdominal pain, melanoma and anemia. She had a history of surgery for a malignant vulval melanoma one year earlier and had been treated with adjuvant interferon α. Computed tomography (CT) concluded to a small bowel intussusception. Exploratory laparoscopy revealed a large tumor arising from the proximal small bowel. Jejunal resection with an end-to-end anastomosis was performed. Histological examination showed a metastasis of malignant melanoma. Regular postoperative follow-up did not show any sign of recurrence. Results and discussion Gastrointestinal metastases are a vicious site of distant localization of melanoma, difficult to diagnose and life-threatening due to their potential complications. Symptoms are often nonspecific. Rarely complications such as intussusception can be the first clinical presentation. CT, CT enteroclysis, fluorodeoxyglucose-positron emission tomography scan and capsule endoscopy may result as very useful for detecting gastrointestinal metastases. Conclusions Any gastrointestinal symptom in patients previously treated for cutaneous melanoma should lead to accurate research for metastases. We propose to use at follow-up abdominal CT scan in asymptomatic patients when the primary tumor has poor prognostic factors such as advanced stage or incomplete resection.

Capsule Endoscopy: Is it Really Helpful in the Diagnosis of Small Bowel Diseases?

Objective: To determine the diagnostic yield and safety of capsule endoscopy for small bowel diseases. Introduction: The small bowel evaluation for any pathology has always been a difficult task because both upper GI endoscopy and colonoscopy could not access this area and other radiological tools like barium studies and CT enteroclysis were less sensitive with associated risk of radiation exposure. Only Push enteroscopy could evaluate the small bowel effectively but was laborious and invasive. Capsule endoscopy was introduced in year 2000 and was accepted with great enthusiasm all over the world3. Now, during the past few years it has also been used for the diagnosis of acute gastrointestinal bleeding in emergency departments and results are quite encouraging 5,6. The procedure was introduced at Department of Gastroenterology-Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan in year 2009. Since then, it has been regularly used for investigation of small bowel abnormalities. Methods: Video Capsule Endoscopy (VCE) using GIVEN Imaging system was performed on 60 patients having various indications like obscure GI bleeding, undiagnosed iron deficiency anemia, abdominal pain and malabsorption. This was a retrospective analytic study carried out at the Department of Gastroenterology-Hepatology Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan from February 2009 to June 2014. Statistical Analysis was done using SPSS version 22. Results: Out of 60 patients, 41 (68.33%) were male, 19 (31.67%) were female. Mean age was 52 years with minimum 11 years and maximum of 85 years. No lesion was found on examination in 8.33% (n=5) patients while presence of blood in the gut resulted in poor visualization in 3.33% (n=2) patients. In remaining 88.34% (n=53) patients, the procedure detected various intestinal lesions. Our study detected presence of Angioectasias in 30.0% (n=18), visible vessels in 6.67% (n=4), strictures in 5.0% (n=3), small bowel ulcers in 10.0% (n=6), edema and erosions in 8.33% (n=5), loss of villi in 11.68% (n=7), intestinal worms in 3.33% (n=2), mass lesions in 8.33% (n=5) and Angioectasia with ulcers in 5.0% (n=3) of patients. The diagnosis in 3 patients was further verified by surgical operation, while enteroscopy was done in 2 patients for confirmation. Capsule impaction occurred in 2 patients. All images of Video Capsule Endoscopy (VCE) were of good quality. Conclusion: Capsule endoscopy is a safe and effective procedure with a good diagnostic yield and can be used routinely for the diagnosis of small bowel diseases.

CT enterography: technical and interpretive pitfalls.

CT enterography is a first-line test at many institutions to investigate potential small bowel disorders. While numerous articles have focused on the ability of CT enterography to diagnose and stage Crohn's disease, small bowel neoplasia, and malabsorptive or vascular disorders, this article reviews CT enterography limitations, technical and interpretive pitfalls, image review tactics, and complementary radiologic and endoscopic examinations to improve diagnostic accuracy. CT enterography limitations include its inability to demonstrate isolated mucosal abnormalities such as aphthous ulcers and its use of ionizing radiation. The most common technical pitfall of CT enterography is inadequate small bowel distention resulting from inadequate ingestion, gastric retention, or rapid small bowel transit of a large volume of neutral enteric contrast material. Additionally, segments of jejunum are frequently collapsed. Interpretive pitfalls commonly result from peristaltic contractions, transient intussusception and opaque intraluminal debris. Opaque debris is especially problematic during multiphasic CT enterography performed to identify potential small bowel sources of obscure gastrointestinal bleeding. False-negative examinations may result from inadequate radiation dose. Examinations complementary to CT enterography include small bowel follow through, enteroclysis, CT enteroclysis, MR enterography, MR enteroclysis, capsule endoscopy, and balloon-assisted endoscopy. Properly performed and accurately interpreted CT enterography contributes to the diagnosis and management of small bowel disease by itself and as a complement to other radiologic and optical small bowel imaging examinations.

CT enteroclysis/enterography findings in drug-induced small-bowel damage.

To evaluate the CT enteroclysis (CTE)/enterography findings of patients with small-bowel mucosal damage induced by aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and to compare these findings with the duration of drug use and endoscopic findings. CTE findings of 11 patients (22 lesions) with drug-induced small-bowel damage were reviewed, including 8 NSAID users and 3 aspirin users. Three patients were short-term users (6 months or shorter) and eight were long-term users (3 years or longer). Nine patients also underwent videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE). Small-bowel abnormalities were visible in 8 of 11 patients (73%) on CTE. Multiple lesions were seen in five patients, including all short-term users. Lesions were classified into three types. Type 1 (mucosal patchy enhancement) was found in four of eight patients (50%, 12 lesions) all were short-term users. Small erosions with mild oedema/redness were shown by DBE. Type 2 (homogeneous hyperenhancement) was found in two of eight patients (25%, four lesions) who were long-term users. Large ulcers with marked oedema/redness were shown by DBE. Type 3 (stratification enhancement) was found in four of eight patients (50%, six lesions), both short-term and long-term users. Annular or large ulcers with strictures were shown by VCE or DBE. On CTE, Type 1 lesions in patients with mostly short-term aspirin or NSAID use, Type 2 lesions in patients with long-term use and Type 3 lesions in both types of patients were detected. CTE may have usefulness for the detection of mild damage. Small-bowel abnormalities owing to aspirin or NSAID present with three different patterns on CTE.

Gastroenteropancreatic endocrine tumors

Gastroenteropancreatic neuroendocrine tumors (GEP-NET) are a rare, heterogeneous group of neoplasms. Only 2% of gastrointestinal tumors belong to the group of neuroendocrine neoplasms. A wide spectrum of diagnostic imaging modalities is available: apart from ultrasound not only computed tomography (CT) but also magnetic resonance imaging (MRI) and positron emission tomography CT (PET-CT) play an important role in detection and staging of GEP-NETs. The PET-CT technique with somatostatin analogues is used for staging as well as for evaluation and monitoring of treatment with peptide radionuclide radiation therapy. According to the literature NETs of the small bowel with a size over 3 cm can be detected with a sensitivity of 84.7% and a specificity of 96.6% using CT enteroclysis and MR enteroclysis provides the detection of NETs of the small bowel in 93.3% of cases. 'The sensitivity of MRI in detection of pancreatic NETs is between 74% and 100% and is, therefore, higher than CT. Detection of small primary tumors is carried out using PET-CT and seems to be the most sensitive imaging modality to identify the exact location. On the other hand MRI has to be regarded as the best imaging modality for detection of liver metastases compared to CT and PET-CT. The role of diagnostic imaging is to identify the exact location of the primary tumor and possible metastases, to define an appropriate therapy and to monitor treatment effects; however, the choice of the most appropriate diagnostic imaging modality varies depending on the location and type of the primary tumor. The GEP-NETs are predominantly well-vascularized; therefore, dual-phase CT/MR imaging with the arterial and venous phases after contrast media injection is mandatory for detection and localization of primary tumors and metastases. For whole body staging CT and PET-CT should be performed.

Idiopathic Localised Dilatation of the Ileum: Computed Tomography Enteroclysis

Idiopathic localised dilatation of the ileum is a rare condition in which one or more segments of the ileum are dilated with abrupt transition to normal segments proximally and distally. To the best of our knowledge, this is the first case report to describe the findings and highlight the potential advantages of computed tomography enteroclysis to assess this condition.

Meckel's diverticulum revealed by microcytic anemia: The contribution of CT enteroclysis

Meckel's diverticulum revealed by microcytic anemia: The contribution of CT enteroclysis