Prognostic value of multidetector computed tomography in bowel infarction [Valore prognostico della tomografia computerizzata multidetettore nell'infarto intestinale]

Purpose: This study aimed to correlate computed tomography (CT) findings and outcomes in patients affected by bowel infarction. Materials and methods: Twenty-seven patients with bowel infarction due to vascular obstruction were evaluated with multidetector CT (MDCT) to establish the prognostic value of CT findings and their correlation with the origin of the ischaemia. The chi-square test was used to analyse the results (p≤0.05). Results: MDCT images allowed recognition of the nature of ischaemia in all cases. In particular, arterial occlusion was found in 67% of patients and venous obstruction in 33%. The overall mortality rate was 63%. Outcome closely correlated with the kind of vascular obstruction, with a mortality rate of 89% in arterial forms and 11% in venous forms. Bowel-wall hyperdensity (2/9 venous occlusions), loss of wall enhancement (1/9 venous occlusions, 2/18 arterial occlusions) and wall thickening (8/9 venous obstructions, 2/18 arterial occlusions) were predictive of good outcome. Bowel-loop dilatation (4/9 venous occlusions, 13/18 arterial occlusions), intramural pneumatosis (1/9 venous occlusions, 17/18 arterial occlusions), mesenteric venous gas (2/9 venous occlusions, 11/18 arterial occlusions), portal venous gas (1/9 venous occlusions, 4/18 arterial occlusions), pneumoperitoneum (8/18 arterial occlusions) and neumoretroperitoneum (1/18 arterial occlusions) were predictive of poor outcome. Ascites (6/9 venous occlusions, 12/18 arterial occlusions) did not add any prognostic information. Conclusions: MDCT is able to detect the nature of bowel ischaemia and provide important prognostic information. © 2009 Springer-Verlag.