Cross-Sectional imaging of high-and low-grade bowel obstruction from crohn's disease using multidetector CT and MRI, including enteroclysis and enterography techniques

Chiara Villa, Massimo Tonolini, Alessandro Campari, Anna Ravelli, Roberto Bianco, Gianpaolo Cornalba

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Mechanical bowel obstruction is relatively common in patients affected with Crohn's disease (CD) during their lifetime and can be caused by acute disease exacerbation, chronic fibrotic changes or postoperative adhesions. Tipically, the initial management of this condition is conservative consisting of medical treatment, whereas the presence of a complete obstruction that is non-responsive to drugs or involves fibrotic strictures requires endoscopic dilatation, surgical resection, or stricturoplasty. Multidetector contrast-enhanced computed tomography (MDCT) including multiplanar reformations, taking advantage of the intrinsic endoluminal contrast provided by the retained fluid, represents the primary cross-sectional modality for imaging acute, severe intestinal obstruction. This methodology allows for the visualization of mural, endoluminal and extramural abnormalities as well as to confirm the presence of obstruction, to grade its severity, to identify the transition point between dilated and collapsed loops, and finally to clarify the most probable cause and detect strangulation. Conversely, state-of-the-arte MDCT and Magnetic Resonance (MRI) volume-challenge techniques such as CT/MRI enteroclysis and enterography allow for an investigation of low-grade intestinal obstruction, that provides: a visualization of number, site, and length of stenosis; the presence of signs of acute inflammation or mural fibrosis; and the detection of any possible extraluminal associated complication. Colonic strictures may be further visualized using MDCT acquisition with retrograde water enema. Discussion of cross-sectional imaging techniques and of imaging appearances of different grades and forms of intestinal obstruction in CD patients is intended to provide correct diagnostic assessment that is necessary for planning an optimal treatment choice.

Original languageEnglish
Title of host publicationCrohn's Disease: Classification, Diagnosis and Treatment Options
PublisherNova Science Publishers, Inc.
Pages155-172
Number of pages18
ISBN (Print)9781626185838
Publication statusPublished - 2013

Keywords

  • Bowel obstruction
  • Cross-sectional imaging
  • Enteroclysis
  • Enterography
  • Multidetector CT

ASJC Scopus subject areas

  • Medicine(all)

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