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Small Intestine Transplantation

KEY FACTS Terminology Isolated small bowel transplant (SB Tx) is primarily for "short gut syndrome" Multivisceral Tx (SB, liver, ± pancreas, ± part of stomach) Usually for liver failure due to chronic total parenteral nutrition (TPN) Donor bowel has copious lymphoid tissue and bacteria Higher prevalence of rejection and infectious complications than solid visceral Txs Imaging Vascular complications: Thrombosis, stricture, pseudoaneurysm (arteries or veins) Less common…

Bowel Ischemia

KEY FACTS Terminology Small bowel (SB) ischemia resulting from mesenteric arterial or venous narrowing or occlusion, leading to inadequate supply of nutrients and oxygen Imaging Best imaging tool CT angiography; multiplanar reformations; water for oral contrast Catheter angiography for confirmation & treatment Imaging findings vary, based on etiology and acuity of ischemic injury Acute arterial thrombosis or embolus Little SB wall thickening, mesenteric edema, or ascites…

Pneumatosis of the Intestine

KEY FACTS Terminology Pneumatosis is descriptive sign, not disease or diagnosis Cystic or linear collections of gas in subserosal or submucosal layers of GI tract wall Pneumatosis intestinalis: Most common form of intramural gas, found in small bowel more often than colon Pneumatosis coli: Rounded collections of gas in distal colonic wall, usually asymptomatic finding You’re Reading a Preview Become a Clinical Tree membership for Full…

Crohn’s Disease

KEY FACTS Terminology Disease of unknown etiology characterized by transmural inflammation of GI tract Imaging CT and MR enterography have supplanted most barium studies for diagnosis in adults and children Faster to perform, less operator dependent, more sensitive and specific Allow assessment of extraintestinal disease (e.g., cholangitis; arthritis) Multiplanar CT or MR enterography Distend bowel with water ± neutral contrast agent (e.g., VoLumen) Bolus IV contrast medium…

Small Bowel Obstruction

KEY FACTS Terminology Obstruction or blockage of ≥ 1 small bowel (SB) segments by intrinsic or extrinsic narrowing of SB lumen Imaging SB > 3 cm diameter on radiographs, 2.5 cm on CT Air-fluid levels on upright or decubitus radiograph Transition zone between dilated and collapsed bowel is critical to define presence, site, and cause of obstruction All better determined on CT than on plain films…

Ileus

KEY FACTS Terminology Proportional gaseous dilatation of large and small bowel (SB) due to lack of intestinal peristalsis, not mechanical obstruction Imaging CT or abdominal plain films (supine, upright, decubitus) Proportional dilatation of SB and colon with no transition point SB > 3 cm on plain films, 2.5 cm on CT Air-fluid levels on upright and decubitus films Top Differential Diagnoses SB or colonic obstruction Intestinal…

Small Intestine: Imaging Approach and Differential Diagnosis

Embryology and Congenital Malformations The small intestine and the right side of the colon constitute the embryologic midgut, which herniates into the umbilical cord during the process of marked elongation in fetal development. Following a 270° counterclockwise rotation, the midgut returns to the peritoneal cavity. Errors during this complex series of events are common, resulting in varying degrees of malrotation ± volvulus. This may result in…