Introduction Colonic wall thickening is commonly seen on computed tomography (CT).1,2 The clinical significance is usually unknown and in the absence of guidance, clinicians often face a dilemma to investigate further and send patients to endoscopy. This retrospective study aims to evaluate what proportion of colonic wall thickening at CT correlated to pathology after endoscopic evaluation and to determine if colonic wall thickening at CT always warrants a lower GI endoscopy.
Methods A retrospective review of all CT scan reports was performed from 2011 to 2014 at University Hospitals Birmingham NHS Trusts. The database was searched for CT reports which included colonic or bowel wall thickening. Patients with underlying diseases explaining bowel wall thickening were excluded. After selection of relevant cases, anonymised data was collected for gender, age, indication, CT findings and final diagnosis after lower GI endoscopy and biopsy.
Results In total, 116 patients with colonic wall thickening reported at CT were found. Chiefly, this was limited to one segment of the colon in 96 patients (82.8%), mostly left sided (59.5%, 69/116). The primary reason for requesting a CT scan was to investigate abdominal pain (48.3%, 56/116). Of the patients with colonic wall thickening at CT, only 51.7% (60/116) proceeded onto lower GI endoscopy with diverticular disease (25%, 15/60) as the main pathology and adenocarcinoma in 9% (5/60). A normal endoscopy was found in 39% (23/60).
Conclusion CT scans will often identify colonic wall thickening (2). Subsequent endoscopic examination was performed in just over 50% of patients with a pathological yield of 61.7%. We recommend endoscopic evaluation where colonic wall thickening is demonstrated at CT for patients without existing diagnosis.
References 1 Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. Am J Roentgenol 2001;176:5:1105–1116.
2 Desai RK, Tagliabue JR, Wegryn SA, Einstein DM. CT evaluation of wall thickening in alimentary tract. Radiographics. 1991 Sep;11(5):771–83.
Disclosure of Interest None Declared
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