Skip to main content
Log in

MDCT in acute ischaemic left colitis: a pictorial essay

  • ABDOMINAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

The pathogenesis of acute ischaemic colitis depends on two different forms of vascular colonic insult: occlusive injury and non-occlusive injury. Clinically, ischaemic colitis may be classified as two major forms: mild (non-gangrenous) and acute fulminant (gangrenous). The classic presentation is abdominal pain, diarrhoea and/or rectal bleeding, but it is not specific and highly variable and so the diagnosis usually depends on clinical suspicion and is supported by serologic and colonoscopic findings. Imaging methods have their role in diagnosing IC. While plain radiography and ultrasound can orient the diagnosis, CT allows to define the morphofunctional alterations discriminating the non-occlusive forms from the occlusive forms and in most cases to estimate the timing of ischaemic damage. Purpose of the review is to define the role of CT in the early identification of pathological findings and in the definition of evolution of colonic ischaemic lesions, in order to plan the correct therapeutic approach, suggesting the decision of medical or surgical treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Berritto D, Iacobellis F, Mazzei MA (2016) MDCT in ischaemic colitis: how to define the aetiology and acute, subacute and chronic phase of damage in the emergency setting. Br J Radiol. 89(1061):20150821

    Article  PubMed  PubMed Central  Google Scholar 

  2. Iacobellis F, Berritto D, Fleischmann D et al (2014) CT findings in acute, subacute, and chronic ischemic colitis: suggestions for diagnosis. Biomed Res Int. 2014:7

    Article  Google Scholar 

  3. Feuerstad P, Brandt L (2015) Update on colon ischemia: recent insights and advances. Curr Gastroenterol Rep 17(12):45

    Article  Google Scholar 

  4. Di Grezia G, Gatta G, Rella R, Donatello D, Falco G, Grassi R, Grassi R (2017) Abdominal hernias, giant colon diverticulum, GIST, intestinal pneumatosis, colon ischemia, cold intussusception, gallstone ileus, and foreign bodies: our experience and literature review of incidental gastrointestinal MDCT findings. BioMed Res Int

  5. Lawrence JB, Feuerstadt P, Logstreth GF et al (2015) ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol 110:18–44

    Article  Google Scholar 

  6. Mazzei MA, Mazzei FG, Marrelli D, Imbriaco G, Guerrini S, Vindigni C, Civitelli S, Roviello F, Grassi R, Volterrani L (2012) Computed tomographic evaluation of mesentery: diagnostic value in acute mesenteric ischemia. J Comput Assist Tomogr 36(1):1–7

    Article  PubMed  Google Scholar 

  7. Grassi R, Di Mizio R, Pinto A, Romano L, Rotondo A (2004) Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus. Radiol Med 108(1–2):56–70

    PubMed  Google Scholar 

  8. Berritto D, Somma F, Landi N, Cavaliere C, Corona M, Russo S, Fulciniti F, Cappabianca S, Rotondo A, Grassi R (2011) Seven-Tesla micro-MRI in early detection of acute arterial ischaemia: evolution of findings in an in vivo rat model. Radiol Med 116(6):829–841

    Article  CAS  PubMed  Google Scholar 

  9. Di Grezia G, Prisco V, Iannaccone T et al (2017) Ultrasonography abdominal findings in over 80-year-old-bedridden patients: psychodiagnostic assessment and management. Gazzetta Medica Italiana Archivio per le Scienze Mediche 176(11):583–586

    Google Scholar 

  10. Valentini V, Buquicchio GL, Galluzzo M, Ianniello S, Di Grezia G, Ambrosio R, Trinci M, Miele V (2016) Intussusception in adults: the role of MDCT in the identification of the site and cause of obstruction. Gastroenterol Res Pract 2016. Article number 5623718

  11. Reginelli A, Iacobellis F, Berritto D, Gagliardi G, Di Grezia G, Rossi M, Fonio P, Grassi R (2013) Mesenteric ischemia: the importance of differential diagnosis for the surgeon. BMC surgery 13(2):S51

    Article  PubMed  PubMed Central  Google Scholar 

  12. Reginelli A, Capasso R, Ciccone V, Croce MR, Di Grezia G, Carbone M, Maggialetti N, Barile A, Fonio P, Scialpi M, Brunese L (2016) Usefulness of triphasic CT aortic angiography in acute and surveillance: our experience in the assessment of acute aortic dissection and endoleak. Int J Surg 33:S76–S84

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Graziella Di Grezia.

Ethics declarations

Conflict of interest

Authors declare that there is no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent has been obtained from all patients.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Grezia, G., Gatta, G., Rella, R. et al. MDCT in acute ischaemic left colitis: a pictorial essay. Radiol med 124, 103–108 (2019). https://doi.org/10.1007/s11547-018-0947-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-018-0947-7

Keywords

Navigation