CT Imaging of Acute Bowel Ischemia and Infarction - Department of ...

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Pathology Ischemia and Infarction: Contributing Factors • 1 = mucosal ischemia – aka ischemic enteritis/ colitis – Reversible mucosal erosions and ulcerations Important to realize that acute bowel ischemia does NOT refer to a single – Partial mural necrosis entity, with but possible rather repair a spectrum +/- residual of disease! fibrotic strictures • 2 = submucosal/ muscularis ischemia • 3 = transmural ischemia – aka bowel infarction – Non-reversible transmural gangrenous necrosis • Post-ischemic inflammatory response – i.e. release of a myriad of cytokines – Contributes to necrosis and further compromises mucosal integrity • Super-infection (esp. colon) – Translocation of intra-luminal bacteria, leading to mural infection, bacteremia and sepsis (high mortality)
Pathology Etiologies 1. Occlusive (75%): Arterial (thromboembolism) 2. Non-occlusive (25%): Venous (bowel obstruction) • Occlusive (75%) – Mesenteric arterial (90%) • Ex. Thromboembolism (atrial fibrillation, aortic), mesenteric thrombosis, dissection etc. – Mesenteric venous (10%) • Ex. Neoplasm, infection, hypercoagubility (polycythemia, sickle cell, antithrombin III, protein C/S, oral contraceptives) etc. • Non-occlusive (25%) – Mechanical (bowel obstruction) • (a) Strangulation of mesenteric veins • (b) Over-distension with subsequent compromise of the local mucosal microcirculation – Hypoperfusion/ Vasospasm • Ex. Shock (hemorrhagic, septic, cardiogenic), severe dehydration, IVDU, pheochromocytoma, familial dysautonomia etc. – Inflammatory • Ex. Pancreatitis, appendicitis, diverticulitis, peritonitis etc. – Vasculopathy • Ex. Vasculitis (i.e. young patients, unusual sites), diabetic vasculopathy, fibromuscular dysplasia etc. – Others • Ex. XRT, chemotherapy, immunosuppression, corrosive injury etc.
Page 1 and 2: CT Imaging of Acute Bowel Ischemia
Page 3 and 4: Anatomy Vascular Supply of Bowel: A
Page 5 and 6: Anatomy Vascular Supply of Bowel: V
Page 7: Pathology Ischemia and Infarction:
Page 11 and 12: Pathology Etiologies: Occlusive SMA
Page 13 and 14: Pathology Etiologies: Occlusive Aor
Page 15 and 16: Pathology Etiologies: Non-occlusive
Page 17 and 18: CT Technique: Ischemic Bowel Protoc
Page 19 and 20: CT Findings: Approach • Distribut
Page 21 and 22: CT Findings: Bowel Thickening • s
Page 23 and 24: CT Findings: Fluid • (a) Fat stra
Page 25 and 26: CT Findings: Air Pneumotosis Portal
Page 27 and 28: CT Findings: Complications • Perf
Page 29 and 30: Cases Case #1: Large bowel ischemia
Page 31 and 32: Cases Case #2: Large bowel ischemia
Page 33 and 34: Cases Case #3: Small bowel Ischemia
Page 35 and 36: Cases Case #4: Small and large bowe
Page 37 and 38: Cases Case #5: Small bowel obstruct
Page 39: Cases 1. 2678623 = large bowel isch

CT Imaging of Acute Bowel Ischemia and Infarction - Department of ...

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