Gastrointestinal Tract Perforation: MDCT Findings according to the Perforation Sites

Our objective is to describe the characteristic CT findings of gastrointestinal (GI) tract perforations at various levels of the gastrointestinal system. It is beneficial to localize the perforation site as well as to diagnose the presence of bowel perforation for planning the correct surgery. CT has been established as the most valuable imaging technique for identifying the presence, site and cause of the GI tract perforation. The amount and location of extraluminal free air usually differ among various perforation sites. Further, CT findings such as discontinuity of the bowel wall and concentrated free air bubbles in close proximity to the bowel wall can help predict the perforation site. Multidetector CT with the multiplanar reformation images has improved the accuracy of CT for predicting the perforation sites.

Nonleukemic Granulocytic Sarcoma of the Ileum: A Case Report

Granulocytic sarcoma is an uncommon clinical condition that usually occurs in the bone, periosteum, soft tissue, lymph node and skin, and this is rarely seen in the gastrointestinal tract. To the best of our knowledge, few cases of granulocytic sarcoma in the small bowel have been reported in the English literature. We present here a case of nonleukemic granulocytic sarcoma of the ileum in a 42-year-old patient who had no evidence of blood or bone marrow involvement that would have been suggestive of acute leukemia or myeloproliferative disorders.

Phlegmonous Enteritis in a Patient with Congestive Heart Failure and Colon Cancer

Phlegmonous enteritis is a rare infective inflammatory disease of the intestine, predominantly involving the submucosal layer. It is difficult to diagnose and often fatal. Its association with alcoholism and various liver diseases, although rarely reported, is well documented. We report a case of phlegmonous enteritis in a male patient with congestive heart failure and colon cancer, and describe the ultrasonographic and CT findings.

Diffuse Eosinophilic Gastroenteritis with Antral Obstruction: A Case Report

Eosinophilic gastroenteritis is a rare disease characterized by tissue eosinophilia that can involve different layers of the gut wall and cause various gastrointestinal symptoms. We describe the UGI and CT findings of a case of diffuse eosinophilic gastroenteritis with tumor-like antral obstruction due to thickening of the submu-cosa and muscle layer in a 21-year-old male.

Radiologic Findings of Submucosal Tumors of Gastrointestinal Tract

Gastrointestinal submucosal tumors originate from submucosal histologic structures such as muscles, lymph nodes, nerves, fibers and vessels. Most patients are asymptomatic. Lesions that are large or ulcerated may cause abdominal pain or upper gastrointestinal bleeding, and those that grow intraluminally sometimes become pedunculated and occasionally prolapse to cause intussusception. Adenocarcinoma is the most common primary gastrointestinal tumor, accounting for approximately 90-9 5 % of such lesions, while submucosal tumors account for approximately 2 -6% of all gastrointestinal tumors. Because their overlying mucosa appears normal, submucosal tumors age after difficult to visualize endo-scopically, and for this reason, barium studies or CT scans are helpful for diagnosis. In this paper, variable CT and barium study findings of the different types of gastrointestinal submucosal tumor are demonstrated, and a brief discussion of the respective disease entities is included.

Usefulness of MR Imaging for Diseases of the Small Intestine: Comparison with CT

OBJECTIVE: To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT. MATERIALS AND METHODS: Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared. RESULTS: MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients. CONCLUSION: MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction. is a high-speed, heavily T2-weighted sequence with a great sensitivity for fluid (11). This advance may make it possible to use breath-hold turbo spin-echo MR.

CT Features of Primary Colorectal Signet-Ring Cell Carcinoma

PURPOSE: To evaluate the CT features of 15 patients with primary colorectal signet-ring cell carcinomas. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 15 patients (mean age, 44 years) with pathologically proven colorectal signet-ring cell carcinoma. The CT findings were evaluated in terms of site and length of the tumor, bowel wall thickening patterns, perirectal or pericolic infiltration, the presence or absence of colonic obstruction, and metastasis to other organs. RESULTS: The tumors were located in the rectum in nine patients, the sigmoid colon in one, the hepatic flexure in one, the transverse colon in one, the ascending colon in two, and the cecum in one. Tumor length ranged from 3.0 to 10.0 (mean, 6.1) cm, with a mean thickness of 2.1 cm. CT revealed concentric bowel wall thickening in all patients, and this was 'even' in eight and 'uneven' in seven. A target appearance was noted in four, perirectal or pericolic infiltration was moderate to severe in 12, and colorectal obstruction was seen in six. With regard to patterns of tumor spread, lymphadenopathy was noted in 13, invasion of adjacent pelvic organs in five, peritoneal carcinomatosis in four, liver metastasis in two, and periureteric metastasis in one. CONCLUSION: When CT shows a long section of concentric bowel wall thickening and a target sign, especially when such findings occur in the rectum and in young patients, primary signet-ring cell carcinoma should be included in the differential diagnosis.

Multiple Lymphomatous Polyposis of the Gastrointestinal Tract: Report of Three Cases

In 1961, Cornes first introduced the term multiple lymphomatous polyposis(MLP), and since then, this very raredisease has been considered as a malignant lymphoma originating in the mantle zone of gastrointestinal lymphoidtissue. MLP presents with a 0.5-2.0cm sized polypoid tumor, which affects long segments of the alimentary tractand frequently invades the mesenteric lymph nodes. It often consists of a dominant mass rather than polyps. Wedescribe three cases of endoscopically proven multiple lymphomatous polyposis, and include a review of theliterature. In differentiating multiple lymphomatous polyposis and other types of multiple polyposis in thegastrointestinal tract, the following features are helpful : the smooth surface of polyps, which is similar to agem seen during a barium examination ; the typical appearance of a gastric submucosal tumor and hypertrophiedgastric mucosal folds in UGI; the presence of enlarged lymph nodes, as seen on abdominal CT scanning.

Usefulness of CT in Patients with Gastrointestinal Fistula

PURPOSE: To evaluate the usefulness of CT in patients with gastrointestinal fistula. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 17 patients with various type of gastrointestinal fistula. The presence of these fistulae was confirmed by laparotomy in seven patients and by barium studies in fifteen. We evaluated the diagnostic accuracy of CT in these cases, and in correlation with barium studies and surgical findings, subsequently analyzed the CT findings. We determined the presence or absence of fistula tract, flow diversion of oral contrast media, bowel wall changes adjacent to the fistula tract, and extraluminal manifestations such as soft tissue mass, free air, leakage of oral contrast media, and peritoneal changes. RESULTS: The diagnosis of gastrointestinal fistula was possible on CT in nine (53%) of the 17 patients by using the CT criteria of direct visualization of the fistula tract (n=6) or flow diversion of oral contrast media (n=4). Other ancillary findings included bowel wall thickening adjacent to fistula tract in 15 patients, extraluminal soft-tissue mass in five, extraluminal free air in ten, extraluminal contrast leakage in four, and varying degrees of mesenteric and/or omental infiltration in 15. CONCLUSION: CT scanning is useful for the diagnosis of gastrointestinal fistula, which may be possible if the fistula tract and flow diversion of oral contrast materials are seen. It is also useful for evaluation of the extent of the etiologic disease.

The Value of CT in detecting Pathologic Bowel Perforation

PURPOSE: To evaluate the usefulness of CT for assessing the location and cause of pathologic gastrointestinal perforation. MATERIALS AND METHODS: A retrospective analysis of abdominal CT was performed in 27 perforations of 26 patients with underlying gastrointestinal pathology. Fifteen benign and 12 malignant perforations consisted of five gastric cancers, one gastric ulcer, ten duodenal bulb ulcers, two bowel adhesions, one jejunal metastasis from lung cancer, one ileocolic Crohn's disease, one radiation colitis and six colon cancers. CT scans were evaluated for 1) diagnosis of bowel perforation, 2) assessment of the cause and site of perforation, and, in particular, differentiation between benignancy and malignancy, and 3) complications and their extent. RESULTS: CT easily detected varying amounts of free air or fluid collection, and infiltration or abscess formation adjacent to the main lesion, and the diagnosis of gastrointestinal perforation was therefore easy. In 11 of the 12 malignancies (92%), primary tumor was diagnosed, but detection of the site of perforation was possible in only seven cases (7/12, 58%). The 15 benign lesions revealed nonspecific CT findings, and the perforation site could be presumed in six (6/15, 40%). In one case of Crohn's disease, the primary cause was visualized. Among six colonic cancers, four pericolic abscesses and two fistulas to adjacent organs were found, but there was no evidence of diffuse peritonitis. CONCLUSION: CT was helpful to lead to optimal treatment of pathologic gastrointestinal On CT, the detectability of perforation, primary benign or malignant lesion, perforation site and extent of complication was high, and this modality was therefore a useful indicator of the optimal treatment for pathologic gastrointestinal perforations.

CT Findings of Enteric Fistula

Enteric fistulae result from gastrointestinal perforations in which communication is established between the site of perforation and another hollow viscus, potential space, or skin surface. Certain types of enteric fistulae are difficult to demonstrate by conventional radiographic methods, and CT is unique in its ability to demonstrate the extent and nature of extraluminal changes. The purpose of this study is to illustrate the CT findings of enteric fistulae occurring in a variety of abdominal and pelvic organs.

CT Evaluation of Target-like Bowel Wall Thickening

PURPOSE: The purpose of this study was to evaluate the CT features of target-like bowel wall thickenings and to correlate target layers with histopathologic layers. MATERIALS AND METHODS: We retrospectively analyzed 37 target-like bowel wall thickenings with inner high-, middle low- and outer high attenuated layers on CT scan. Bowel lesions included 15 cases of ischemic lesion, 12 of inflammation, four of carcinomatosis, four of trauma, and two of radiation enteritis. Target-like bowel wall thickenings were classified into three types : with inner most thickened high-attenuated layer(type I); with middle most thickened low-attenuted layer(type II), and with outer most thickened high-attenuated layer(type III). We analyzed the characteristic CT features of these bowel lesions and correlated target and histopathologic layers in resected bowel specimens. RESULTS: Target-like bowel wall thickening was type I in 18 cases(49%), type II in 13 cases(35%), and type III in 6 cases(16%). Type I ischemic bowel lesions and inflammations were most common, and were found in 60% and 67% of cases, retrospectively. All cases of trauma were type II and radiation colitis was type III. Histopathologic findings showed that each layer of target lesions did not exactly correlate with histopathologic layers. However, the inner high attenuated layer correlated with mucosa and some submucosa, the middle low-attenuated layer correlated with most submucosa and some muscularis, and the outer high-attenuated layer correlated with muscularis, serosa, and periserosal mesentery. CONCLUSION: CT features of target-like bowel wall thickenings showed type characteristics according to bowel lesions. Histopathologic comparison and analysis were considered helpful for the differential diagnosis of bowel lesions.

CT Findings of Mucinous Adenocarcinoma in Gastrointestinal Tract

PURPOSE: To evaluate CT findings of mucinous adenocarcinoma in the gastrointestinal tract. MATERIALS AND METHODS : CT scans of 24 gastric and five colorectal mucinous adenocarcinomas, proven by histology, were retrospectively analysed; the patients consisted of 18 men and 11 women (age range, 27-76; mean, 59). CT findings were analysed, with emphasis on : (a) tumor size and maximal wall thickness ; (b) the presence of a low attenuation area, suggestive of a mucin poll within the tumor ; (c) the presence, shape and location of calcification, and (d) correlation between primary tumor (T) staging and CT findings. RESULTS: The mean tumorsize of gastric mucinous adenocarcinoma was 8.2cm (range, 1.4 - 17cm) and the mean maximal wall thickness was2.3cm (range, 1-4.5cm). Low attenuation areas on enhanced CT were seen in 12 cases (50%). Mottled, punctate, diffuse calcifications were demonstrated in nine cases(38%), and were located in low attenuation areas in eight cases. The T staging could be determined in 22 cases. Of there, low attenuation areas were demonstrated in tencases and calcification in seven. Of those ten cases with low atteuation area T staging was T2 in two cases, T3 intwo, and T4 in six. Of the cases showing calcification, T staging was T3 in one case and T4 in six. The mean sizeof colorectal mucinous adenocarcinoma was 6cm(range, 3-13cm) and the mean maximal wall thickness was 3.6cm (range,1.5-7cm). Low attenuation area were seen in three cases. Mottled calcification within the low sttenuation was detected in one case. The T staging of three cases which showed a low attenuation area was T3 in tow cases and T4in one case. One case with calcification was T3 stage. CONCLUSION: The CT finding of mucinous adenocarcinoma inthe gastrointestinal tract was a relatively thick-walled mass containing an area of low attenuation or calcification. Although calcification is believed to be a pathognomonic finding for the specific diagnosis of mucinous adenocarcinoma, a low attenuation area may be an important CT finding because it can be detected at lower T staging and more frequently.