Bowel Wall Thickening on Computed Tomography in Children: A Novel Method of Measurement and Its Clinical Significance

PURPOSE

The clinical implications of bowel wall thickening (BWT) on abdominal computed tomography (CT) among children are unknown. We aimed to suggest a new method for measuring BWT and determining its clinical significance in children.

METHODS

We retrospectively analyzed 423 patients with acute abdomen who underwent abdominal CT; 262 were classified into the BWT group. For this group, the pediatric radiologist described the maximal bowel wall thickness (MT), normal bowel wall thickness (mm) (NT), and their ratios for each segment of the bowel wall.

RESULTS

In the thickened bowel walls, the thickness differed significantly between the small bowel (6.83±2.14 mm; mean±standard deviation) and the colon (8.56±3.46 mm; p<0.001). The ratios of MT to NT in the small bowel (6.09±3.17) and the colon (7.58±3.70) were also significantly different (p<0.001). In the BWT group, 35 of 53 patients had positive fecal polymerase chain reaction results; 6 patients infected with viruses predominantly had BWT in the small intestine, while the terminal ileum and the colon were predominantly affected in 29 patients with bacterial infections. In the initially undiagnosed 158 patients with BWT, the symptoms improved spontaneously without progression to chronic gastrointestinal disease.

CONCLUSION

This study provides a clinical reference value for BWT in the small intestine and colon using a new method in children. The BWT on abdominal CT in children might indicate nonspecific findings that can be observed and followed up without additional evaluation, unlike in adults.

Differential diagnostic value of small bowel wall thickness and density changes measured by computed tomography in small bowel obstruction

AIM: To investigate the diagnostic value of small bowel wall thickness and density measured by computed tomography (CT) in differentiating simple small bowel obstruction (SI) from strangulated small bowel obstruction (ST).

METHODS: Forty-two patients with SI and 38 patients with ST were included. All patients underwent plain and contrast-enhanced CT scans. The density of bowel wall thickening was recorded and compared.

RESULTS: The percentage of patients with normal inner density measured by plain CT was significantly higher in the SI group than in the ST group, and the percentage of patients with decreased whole density was significantly lower in the SI group than in the ST group (P < 0.05). The percentage of patients with decreased whole density measured by contrast-enhanced CT was significantly lower in the SI group than in the ST group (P < 0.05). The sensitivity and specificity of normal inner density measured by plain CT for diagnosis of ST were 34.2% and 33.3%, respectively. The sensitivity and specificity of decreased whole density measured by plain CT were 73.7% and 71.4%, respectively. The sensitivity and specificity of decreased whole density measured by contrast-enhanced CT were 84.2% and 73.8%, respectively.

CONCLUSION: Small bowel wall thickness and density changes measured by computed tomography can help differentiate between SI and ST.

Abdominal computed tomography in refractory coeliac disease and enteropathy associated T-cell lymphoma

AIM: To evaluate computed tomography (CT) findings, useful to suggest the presence of refractory celiac disease (RCD) and enteropathy associated T cell lymphoma (EATL).

METHODS: Coeliac disease (CD) patients were divided into two groups. GroupI: uncomplicated CD (n = 14) and RCD typeI(n = 10). Group II: RCD type II (n = 15) and EATL (n = 7).

RESULTS: Both groups showed classic signs of CD on CT. Intussusception was seen in 1 patient in groupIvs 5 in group II (P = 0.06). Lymphadenopathy was seen in 5 patients in group II vs no patients in groupI(P = 0.01). Increased number of small mesenteric vessels was noted in 20 patients in groupIvs 11 in group II (P = 0.02). Eleven patients (50%) in group II had a splenic volume < 122 cm³vs 4 in groupI(14%), 10 patients in groupI had a splenic volume > 196 cm³ (66.7%) vs 5 in group II (33.3%) P = 0.028.

CONCLUSION: CT scan is a useful tool in discriminating between CD and (Pre) EATL. RCD II and EATL showed more bowel wall thickening, lymphadenopathy and intussusception, less increase in number of small mesenteric vessels and a smaller splenic volume compared with CD and RCDI.