title: MDCT in ischaemic colitis: how to define the aetiology and acute, subacute and chronic phase of damage in the emergency setting.
abstract: Ischemic colitis (IC) is the most common vascular disorder of the gastrointestinal tract with a reported incidence of 6.1-44 cases/100,000 person years with confirmatory histopathology. However, the true incidence of IC poses some difficulty, and even vigilant clinicians with patients at high risk often miss the diagnosis, since clinical presentation is non-specific or could have a mild transient nature. Detection of IC results is crucial to plan the correct therapeutic approach and reduce the reported mortality rate (4-12%). Diagnosis of IC is based on a combination of clinical suspicion, radiological, endoscopic and histological findings. Some consider colonoscopy as a diagnostic test of choice; however, preparation is required and it is not without risk, above all in patients who are severely ill. There are two manifestations of vascular colonic insult: ischaemic and reperfusive. The first one occurs above all during ischaemic/non-occlusive mesenteric ischaemia; in this case, the colonic wall appears thinned with dilated lumen and fluid appears in the paracolic space. When reperfusion occurs, the large bowel wall appears thickened and stratified, because of subepithelial oedema and/or haemorrhage, with consequent lumen calibre reduction. Shaggy contour of the involved intestine and misty mesentery are associated with the pericolic fluid. The pericolic fluid results are a crucial finding for IC diagnosis since its evidence suggests the presence of an ongoing damage thus focusing the attention on other pathological aspects which could be otherwise misdiagnosed, such as thinned or thickened colonic wall. Moreover, the pericolic fluid may increase or decrease, depending on the evolution of the ischaemic damage, suggesting the decision of medical or surgical treatment. Radiologists should not forget the hypothesis of IC, being aware that multidetector CT could be sufficient to suggest the diagnosis of IC, allowing for early identification and grading definition, and in a short-term follow-up, discriminating patients who need urgent surgery from patients in whom medical treatment and follow-up can be proposed.
authors.affiliation: 1 Department of Radiology, Private Hospital "Villa Dei Fiori" S.r.l. Accredited to National Health System, Acerra (NA), Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Berritto
authors.affiliation: 2 Department of Radiology, Second University of Napoli, Napoli, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Iacobellis
authors.affiliation: 3 Department of Medical, Surgical and Neuro Sciences, Section of Radiological Sciences, University of Siena, Siena, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Mazzei
authors.affiliation: 3 Department of Medical, Surgical and Neuro Sciences, Section of Radiological Sciences, University of Siena, Siena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Volterrani
authors.affiliation: 4 Radiology Department, Hospital "Casa Sollievo della Sofferenza", Radiology Department, University of Foggia, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.affiliation: 5 Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.affiliation: 2 Department of Radiology, Second University of Napoli, Napoli, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Grassi
mesh_terms: D000208:Acute Disease; D002908:Chronic Disease; D017091:Colitis, Ischemic / Q000000981:diagnostic imaging*; D003106:Colon / Q000000981:diagnostic imaging; D004632:Emergency Medical Services; D006801:Humans; D061330:Multidetector Computed Tomography