title: Thickened gastrointestinal wall findings on computed tomography in children: a reason for endoscopy?
abstract: OBJECTIVE
  Bowel wall thickening on computed tomography (CT) scans in children may raise concern for inflammatory bowel disease (IBD). The significance of this radiological finding is unclear. Our purpose was to evaluate the clinical outcomes with regard to IBD in children with no known underlying disease, presenting with abdominal pain and thickened bowel wall on CT scan.
  
  
  METHODS
  A retrospective analysis of pediatric patients with abdominal pain and CT findings of thickened bowel wall was performed between 2006 and 2010. Endoscopic findings, clinical variables, and follow-up assessments were evaluated.
  
  
  RESULTS
  Fifty-six patients presenting with abdominal pain and thickened bowel wall findings on CT scan were identified. Overall, 30 (54%) had terminal ileum wall thickening, 17 (30%) had isolated colonic wall thickening, and 9 (16%) had other small bowel wall thickening. Of the 56 patients, 21 (38%) underwent endoscopy, of which 14 (67%) had positive findings-11 (79%) had histologic evidence of chronic colitis, and 5 (36%) had duodenitis/ileitis. Ultimately, 11/56 (20%) were diagnosed as having IBD, 8/56 (14%) with functional abdominal pain/constipation, 9/56 (16%) appendicitis, 10/56 (18%) infectious gastroenteritis, and 18/56 (32%) with miscellaneous diagnoses. Median levels of erythrocyte sedimentation rate, C-reactive protein, albumin, and platelet count were significantly abnormal in the IBD group compared to the non-IBD group. Additional follow-up of those who did not undergo endoscopic evaluation revealed no new diagnoses of IBD.
  
  
  CONCLUSIONS
  The presence of thickened bowel wall on CT scans is a nonspecific finding in children. Laboratory evaluation may help distinguish which patients require additional evaluation and endoscopy.
authors.affiliation: Department of Pediatrics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA. Steven.min@gmail.com
authors.forename: Steve B
authors.initials: SB
authors.lastname: Min
authors.forename: Cade M
authors.initials: CM
authors.lastname: Nylund
authors.forename: Mazen I
authors.initials: MI
authors.lastname: Abbas
authors.forename: Milissa
authors.initials: M
authors.lastname: Carter
authors.forename: Cara H
authors.initials: CH
authors.lastname: Olsen
authors.forename: David M
authors.initials: DM
authors.lastname: Biko
authors.forename: Matheu D
authors.initials: MD
authors.lastname: Goldman
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000473:pathology; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002908:Chronic Disease; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology*; D003248:Constipation / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D005767:Gastrointestinal Diseases / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D010976:Platelet Count; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein