Colonic wall thickening in cirrhotic patients: CT features and its clinical significance

Background: To evaluate the computed tomographic (CT) features of colonic w all thickening in cirrhotic patients and to determine their prognostic valu e. Methods: We retrospectively reviewed 28 cirrhotic patients with colonic wal l thickening (110 mm) on CT. Twenty-six of the 28 patients had hepatocellul ar carcinoma. The severity of hepatic dysfunction was determined by using t he Child-Pugh classification. We analyzed the patterns of bowel wall thicke ning and degree of portal hypertension on CT and the survival periods after initial CT detection of colonic wall thickening. Results: The involved segment of the colon was diffusely thickened with eit her scalloped or nodular circumferential configuration. In all patients, th e thickened colonic wall enhanced poorly. Although the ascending colon was involved in all patients, the transverse (n = 14) or descending (n = 5) col on was also simultaneously involved. Most patients exhibited an advanced st age of portal hypertension on CT. The median survival period of 25 patients who expired was 34 days, and 21 patients (84%) expired within 3 months. Conclusions: Colonic wall thickening on CT can be used as one of the indica tors of poor prognosis in cirrhotic patients. Advanced liver cirrhosis with significantly severe dysfunction is the likely cause of mortality. Therefo re, a less aggressive therapeutic approach is recommended if hepatocellular carcinoma is coexistent in these patients.