title: Spontaneous Intramural Intestinal Hemorrhage versus Acute Mesenteric Ischemia by CT Evaluation.
abstract: Objective The purpose of our study was to differentiate the imaging findings of patients with spontaneous intramural intestinal hemorrhage (SIIH) from those with acute mesenteric ischemia (AMI) after abdominal computed tomography (CT) survey in the emergency department. Methods We retrospectively included 83 patients diagnosed with SIIH or AMI after abdominal CT. Results The mean ages of 30 SIIH patients and 53 AMI patients were 74.4±14.6 years and 75.8±11.2 years, respectively. Patients with SIIH had significantly thicker maximal intestinal wall thickening (14.8±3.9 vs. 10.9 ±4.1, p<0.001), a lower rate of ileum involvement (26.7% vs. 77.4%, p<0.001) and a higher rate of ascites (96.7% vs. 64.2%, p<0.001) compared with patients with AMI. Neither pneumatosis intestinalis (p<0.001) nor portomesenteric gas (p<0.01) were detected in SIIH patients but were observed in AMI patients. A receiver-operating characteristic (ROC) curve analysis showed that the optimal cut-off value for maximal intestinal wall thickening between groups was 10.4 mm and the area under the ROC curve between groups was 0.752 (p<0.0001). A multiple logistic regression analysis showed that the independent predictors of SIIH were non-involvement of the ileum (odds ratio, OR, 6.998; p=0.001), maximal intestinal wall thickening ≥10.4 mm (OR, 5.748; p=0.040) and ascites (OR, 13.348; p=0.023). The area under the ROC curve for the model was 0.854 (p<0.001). Conclusion The independent predictors of SIIH from AMI after abdominal CT in acute abdominal patients include non-involvement of the ileum, intestinal wall thickening ≥10.4 mm, and ascites.
authors: Department of Emergency Medicine, Taichung Veterans General Hospital, Taiwan.
authors: Chia-Ying
authors: CY
authors: Tseng
authors: Chia-Ming
authors: CM
authors: Chang
authors: Shu-Chuan
authors: SC
authors: Yang
authors: Julia
authors: J
authors: Chia-Yu Chang
authors: Jen-Dar
authors: JD
authors: Chen
authors: Hsien-Hao
authors: HH
authors: Huang
authors: Chorng-Kuang
authors: CK
authors: How
authors: David
authors: D
authors: Hung-Tsang Yen
authors: Mu-Shun
authors: MS
authors: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D007082:Ileum / Q000473:pathology; D008297:Male; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed