Incidental colorectal computed tomography abnormalities: would you send every patient for a colonoscopy?
BACKGROUND
The clinical significance of colorectal wall thickening (CRWT) in patients undergoing abdominal computed tomography (CT) has not yet been definitively established.


OBJECTIVE
To compare alleged findings on abdominal CT with those of a follow-up colonoscopy.


METHODS
Ninety-four consecutive patients found to have large-bowel abnormalities on abdominal CT were referred for colonoscopy. Of these patients, 48 were referred for a suspected colorectal tumour and 46 for CRWT. Colonoscopy was performed and findings were compared.


RESULTS
Of the 48 suspected colorectal tumours, 34 were determined to be neoplastic lesions on colonoscopy. Of these, 26 were malignant and eight were benign. Colonoscopy revealed no abnormality in 30 of 46 patients with CRWT as a solitary finding, and revealed some abnormality in 16 patients (12 had diverticular disease, four had benign neoplastic lesions).


CONCLUSIONS
CRWT as an incidental and solitary finding on CT should not be regarded as a pathology prompting a colonoscopy. Approximately two-thirds of the patients had a normal colonoscopy and the remaining patients had benign lesions (12 had diverticular disease and four had benign neoplastic lesions). However, many of these patients seem to warrant colonoscopy regardless of CT findings, particularly patients who have a family history of colorectal cancer, have positive fecal occult blood test results or who are older than 50 years of age.
Stermer
Edy
E
Gastroenterology Service, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel. edystermer@yahoo.com
Lavy
Alexandra
A
Rainis
Tova
T
Goldstein
Omer
O
Keren
Dean
D
Zeina
Abdel-Rauf
AR
D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed