Colonic wall thickening in patients with cirrhosis: CT findings and clinical implications

OBJECTIVE, The purpose of this study was to determine the prevalence and sp ectrum of colonic wall changes in patients with cirrhosis and to determine the association between these colonic wall changes and portal hypertension. MATERIALS AND METHODS. Abdominal CT examinations of 57 patients with cirrho sis were evaluated for colonic abnormalities including bowel wall thickenin g and pneumatosis, The degree and extent of colonic involvement, other CT f eatures of cirrhosis including ascites and portal hypertension, and clinica l symptoms were recorded. A correlation was made with available colonoscopy , exploratory laparotomy, and pathologic results. RESULTS. Colonic wall abnormalities were seen in 37% (21/57) of the patient s with cirrhosis, 25% (14/57) of whom had isolated or predominantly right-s ided colonic changes. Abnormal bowel wall thickening (ranging from 6 mm to 3 cm in thickness) was present in 35% of the patients. Pneumatosis was foun d in 4% of the patients. Of the 18 liver transplant recipients who had CT e xaminations before and after liver transplantation, colonic changes were se en in 44% preoperatively but in only 6% postoperatively. Isolated right-sid ed colonic changes and diffuse colonic changes were associated with varices in 93% and 100% of the patients, respectively; with ascites in 93% and 100 %, respectively; and with splenomegaly in 83% and 86%, respectively. Specif ic or focal bowel symptoms were present in only 29% Of the patients with co lonic changes, whether the changes were diffuse or isolated to the right si de. CONCLUSION. Thirty-five percent of the patients with severe cirrhosis who u nderwent CT were shown to have colonic wall thickening; two thirds of these patients had thickening limited predominantly to the right colon. We postu lated that predominantly right-sided colonic wall thickening may be related to changes in blood flow and hydrostatic pressures caused by portal hypert ension, Many patients with isolated or predominately right-sided colonic wa ll thickening did not have specific or focal bowel symptoms, and in most pa tients, the colonic wall thickening resolved after successful liver transpl antation, requiring no further testing. On the other hand, we found that pn eumatosis or severe diffuse colonic wall thickening may indicate a more ser ious colonic problem such as ischemia or infection with Clostridium diffici le and should prompt further investigation.