Ischemic colitis: CT evaluation of 54 cases

PURPOSE: To review the computed tomographic (CT) scans and medical records of 54 patients with proved ischemic colitis, define the spectrum of CT find ings, and assess the effect of CT imaging on treatment. MATERIALS AND METHODS: The mean age of the patients was 72 years. CT scans were analyzed for the presence of colonic abnormalities and associated find ings. Ischemia was clinically unsuspected in 16 patients (30%). RESULTS: Segmental involvement was seen in 48 patients (89%), with a mean l ength of involvement of 19 cm (range, 5-38 cm). Wall thickness varied betwe en 2 and 20 mm (mean, 8 mm). All parts of the colon were involved. The CT a ppearance of the colonic wall varied: (a) A wet appearance with heterogeneo us areas of edema was seen in 33 patients (61%). (b) A dry appearance with mild homogeneous thickening was seen in 18 patients (33%). (c) Intramural a ir was present in three patients (6%). Ischemia resolved in 41 patients (76 %), and complications occurred in 13 patients (24%). CONCLUSION: CT can be used to confirm the clinical suspicion of ischemic co litis, to suggest ischemia when it is unsuspected, and to diagnose complica tions. Intrinsic colonic abnormalities cannot be used to diagnose;or predic t the development of infarction.