Color Doppler sonography of small bowel wall changes in 21 consecutive cases of acute mesenteric ischemia.
OBJECTIVE
To describe the small bowel wall changes observed with color Doppler sonography in acute mesenteric ischemia with comparison with its outcome.


METHODS
We reviewed the sonographic findings of 21 patients with a final diagnosis of acute mesenteric ischemia (12 acute arterial forms and 9 acute venous forms). These examinations included identification of non peristaltic thin-walled fluid-filled intestinal loops (with or without pneumatosis), thickened intestinal wall (> 3 mm) (noted as stratified or not), and preserved or absent mural flow assessed with color Doppler. Sonographic findings were compared with the surgical data (n = 16) or with the clinical outcome (n = 5).


RESULTS
In acute arterial ischemia, non-peristaltic thin-walled intestinal loops were detected with sonography in five cases, with visualization of pneumatosis in one. Bowel infarction was diagnosed in four of these five patients including one patient with pneumatosis. Thickened bowel loops were sonographically detected in four cases, of which 3 required resection. Conservative therapy was performed in the remaining case having preserved wall stratification and mural flow with color Doppler. In acute venous ischemia, thickened bowel loops were detected with sonography in six cases. Conservative therapy was performed in three cases for whom preserved mural flow was noted. Stratification was present in two of these three cases.


CONCLUSIONS
In acute arterial ischemia, intestinal resection is frequently required when non-peristaltic, thin-walled, fluid-filled loops are detected with sonography. In arterial and venous ischemia, absence of wall stratification and mural flow are frequently associated with ischemia requiring surgery.
Department of Radiology, St-Luc University Hospital, Brussels, Belgium. Eteinne.danse@uclouvain.be
E M
EM
Danse
A
A
Kartheuser
H M
HM
Paterson
P-F
PF
Laterre
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply / Q000000981:diagnostic imaging*; D007511:Ischemia / Q000000981:diagnostic imaging; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging*; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color