Introduction Multiple features of an abdominal CT scan may suggest underlying colitis, many of which are non-specific and may be mimicked by other pathologies. Such incidental findings often lead to difficulty in determining whether colonoscopic investigation is warranted. Studies that have looked at this area do not agree as to the best diagnostic approach for such patients and only included patients who had endoscopic investigations following the abnormal scan. This study aims to establish the clinical significance of an abdominal CT finding of colitis, ascertain how such findings are being investigated and determine whether these patients should undergo colonoscopy.
Methods All patients with CT findings of colitis in a district general hospital from March 2007 to March 2008 were included. Notes of all patients were reviewed over the 2 years following the abnormal CT scan, obtaining details of investigations, diagnosis and outcome.
Results 34 patients were included in our study. 62% were female and the median age was 72. 47% of patients with CT findings of colitis had the diagnosis confirmed with further investigation. 21% of patients had infective colitis, 12% ischaemic colitis and 15% inflammatory bowel disease (IBD). 6% of the total number of patients had a new diagnosis of IBD. 24% of colonoscopies undertaken were normal. 50% of patients did not undergo endoscopic examination because 12% had no GI symptoms, 24% were too unwell, 35% of diagnoses were reached by alternative investigation, 12% were unsuitable for endoscopic examination and 6% declined further investigation. Infective colitis was often poorly investigated with 32% of patients with acute diarrhoea not having a stool culture or clostridium difficile screen. Our results showed a similar incidence of colitis as previous studies but low levels of neoplasia and new diagnoses of IBD. This could be due to the inclusion of patients that did not undergo endoscopic investigation in our analysis. In those patients where endoscopic tests were not carried out based on clinical judgement, no cases of missed serious bowel pathology were found in 2 years follow-up.
Conclusion In conclusion a CT scan suggestive of colitis can reflect serious underlying pathology; however endoscopic investigation is not always indicated. Each case needs to be considered individually, based on clinical presentation, ensuring that the appropriate non-invasive tests are considered first.
Competing interests None declared.
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