Imagerie des ischémies intestinales

doi:10.1016/S0221-0363(04)97626-3

Journal de Radiologie

Volume 85, Issue 4, Part 2, April 2004, Pages 533-538

https://doi.org/10.1016/S0221-0363(04)97626-3 Get rights and content

Résumé

Les atteintes ischémiques intestinales se manifestent sous la forme d’une ischémie mésentérique aiguë, d’une ischémie mésentérique chronique ou d’une colite ischémique. L’imagerie en coupes, et plus particulièrement la tomodensitométrie occupe une place croissante dans la détection de l’ischémie mésentérique aiguë et chronique. Des obstructions et des sténoses vasculaires et des anomalies des parois digestives peuvent être observées. L’IRM permet d’ajouter une information fonctionnelle par l’utilisation de séquences sensibles à la saturation en oxygène de l’hémoglobine dans la veine mésentérique supérieure. L’artériographie reste l’examen de référence dans l’ischémie mésentérique aiguë.

Abstract

Ischemic bowel disease includes acute and chronic mesenteric ischemia, and colon ischemia. Cross-sectional imaging, and more particularly computed tomography, has an increasing role in the detection of acute and chronic mesenteric ischemia. Vascular obstructions or stenoses and changes in the bowel wall can be observed. Functional information can be added with MRI by using sequences that are sensitive to oxygen saturation in the superior mesenteric vein. Arteriography remains the reference examination in patients with acute mesenteric ischemia.

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Cited by (7)

MDCT and MR imaging of the jejunum
2015, Diagnostic and Interventional Imaging
Citation Excerpt :
Venous occlusion may result from strangulated internal hernia, volvulus, venous thrombosis (Fig. 9) or rarely malignant infiltration of the mesentery [57,58]. MDCT findings include jejunal wall thickening in association with thickening of other small bowel segments, spontaneous increased attenuation of small bowel wall, poor enhancement of jejunal wall, intra-abdominal fluid effusion [56]. Parietal gas (i.e., pneumatosis intestinalis) indicates severe disease.
Recent refinements in cross-sectional imaging have dramatically modified the investigation of the jejunum. Improvements in multidetector row computed tomography (MDCT) and magnetic resonance (MR) imaging technology have made detection and characterization of jejunal abnormalities easier. Current options include MDCT and MR imaging using either enterography or enteroclysis. The goal of this pictorial review is to outline the current imaging techniques that are used to investigate the jejunum and illustrate the most common conditions that affect this small bowel segment with a specific focus on MDCT and MR imaging using enterography or enteroclysis. MR imaging used in conjunction with optimal jejunal distension appears as the modality of choice for the diagnosis of a wide range of jejunal abnormalities. MDCT remains the first line imaging modalities because of an acute presentation in a substantial number of patients.
Post-traumatic gastrointestinal hemorrhage. Answer to December e-quid
2011, Journal de Radiologie
Linear or bubbly: A pictorial review of CT features of intestinal pneumatosis in adults
2008, Journal de Radiologie
Pneumatosis intestinalis is a rare condition, which is defined by the presence of gas within the bowel wall. In adult patients, pneumatosis intestinalis can be depicted in various circumstances. Owing to the routine use of CT to investigate patients with abdominal pain, pneumatosis intestinalis can be seen as an incidental finding or can be observed in association with a life-threatening disease such as bowel infarction. On CT images, pneumatosis intestinalis can display two different appearances; one that has a cystic or bubbly appearance can be considered as a chronic pneumatosis and is suggestive for a benign cause while the other, which has a linear appearance can be considered as a symptom and is more frequently secondary to a life-threatening cause. However, none of these two CT characteristics can be considered pathognomonic for any of these two categories of causes. In such situations, the analysis of the location, extent and, if any, associated findings may help to differentiate between benign and life-threatening causes. In these patients who present with abdominal signs that mimic symptoms that would warrant surgical exploration, the analysis of associated findings is critical to rule out a life-threatening cause of pneumatosis intestinalis and to obviate the need for unnecessary laparotomy. In adult patients with a known specific disease such as celiac disease, chronic pseudointestinal obstruction or other chronic diseases, even with accompanying pneumoperitoneum, pneumatosis intestinalis does not uniformly mandate surgical exploration. This pictorial review presents the more and the less common pneumatosis intestinalis CT features in adult patients, with the aim of making the reader more familiar with this potentially misleading sign.
La pneumatose intestinale est un signe radiologique rare, défini par la présence de gaz dans la paroi digestive. Chez l’adulte, ce signe est associé à des pathologies variées. Les indications de la TDM au cours des douleurs abdominales permettent de mettre en évidence ce signe qui peut être découvert de manière fortuite ou, en revanche, traduire une urgence vitale telle qu’une ischémie intestinale. En TDM, il existe deux formes de pneumatose ; l’une constituée de multiples bulles (formes kystiques) et l’autre curviligne (forme linéaire). Si la première est souvent associée à une cause bénigne et peut être considérée comme une pneumatose chronique « maladie », la seconde correspond à une pneumatose symptôme et témoigne le plus souvent d’une affection grave, mettant en jeu le pronostic vital. Cependant, cette relation dichotomique n’est pas toujours vraie, de sorte que quelle que soit la forme de la pneumatose, ce signe doit être systématiquement interprété en fonction du contexte clinique, pour éliminer une urgence vitale ou, au contraire, éviter une laparotomie inutile. En effet, chez l’adulte ayant une pathologie connue telle qu’une maladie cœliaque, une pseudo-obstruction intestinale chronique ou une autre pathologie chronique, et même en présence d’un pneumopéritoine associé, la pneumatose intestinale n’est pas systématiquement une indication opératoire. Cette revue iconographique décrit les aspects tomodensitométriques les plus et les moins fréquents de la pneumatose intestinale de l’adulte afin de rendre le lecteur plus familier avec ce signe souvent trompeur.
Superior mesenteric arterial branch occlusion causing partial jejunal ischemia: A case report
2012, Journal of Medical Case Reports
CT underestimation of ileo-colic ischemia: A case report with pathologic correlation
2009, JBR-BTR
Images in clinical practice
2007, Tunisie Medicale

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Le point sur…Imagerie des ischémies intestinalesImaging of intestinal ischemia

Résumé

Abstract

Gastroenterology

Semin Ultrasound CT MR

Semin Roentgenol

Ann Thorac Surg

Am J Surg

Acad Radiol

Acad Radiol

Acad Radiol

CT and MR imaging findings of bowel ischemia from various primary causes

Radiographics

Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction

AJR

Intestinal blood flow and diseases of vascular impairment

Non-occlusive mesenteric ischemia

Hepatogastroenterology

The sequence of development of intestinal tissue injury after strangulation ischemia and reperfusion

Surgery

Mesenteric venous thrombosis

N Engl J Med

Surgical management of thrombotic acute intestinal ischemia

Ann Surg

Acute mesenteric ischemia: diagnosis with contrast-enhanced

Radiology

Le point sur…
Imagerie des ischémies intestinalesImaging of intestinal ischemia