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CT and bowel disease

Department of Radiology, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ UK

View larger version (100K): [in a new window]   Figure 1. Pelvic CT following abdominal perineal resection, showing slight enhancement of the pre-sacral mass, which also contains a centre of lower attenuation. This was owing to recurrent disease, but the distinction is difficult by imaging criteria alone.

View larger version (67K): [in a new window]   Figure 2. (a) CT in a patient with anaemia. The thickening on the medial wall of the caecum was overlooked, with the carcinoma being demonstrated on a contrast enema 10 months later (b). This case illustrates the point of paying attention to any area of abnormal bowel wall thickening.

View larger version (133K): [in a new window]   Figure 3. Image taken during colography after full bowel preparation and air insufflation demonstrates an annular carcinoma of the caecum (arrows).

View larger version (76K): [in a new window]   Figure 4. Two examples of diverticular disease of the sigmoid and its complications. (a) Marked soft tissue thickening of the sigmoid within which there are diverticula. At this stage much of the change is likely to be collagenous. (b) Low attenuation element indicates a more fluid component due to a pericolic abscess. Note in both examples the prominent vascularity around the lesion and the changes in the pericolic fat.

View larger version (144K): [in a new window]   Figure 5. Crohn's colitis demonstrating marked inflammatory changes in the perirectal fat together with considerable bowel wall thickening of both the rectum and sigmoid.

View larger version (119K): [in a new window]   Figure 6. Prominent thickening of the bowel wall in the ascending colon completely obliterates the lumen in a case of pseudomembranous colitis. Note that the left colon is not so severely involved. There is also hyperaemia of the mucosa.

View larger version (91K): [in a new window]   Figure 7. Two examples of acute appendicitis with (a) distended fluid-filled lumen of the appendix together with some enhancement of its wall, and (b) more prominent inflammatory change extending into the pericaecal area.

View larger version (111K): [in a new window]   Figure 8. Lymphoma of the small bowel showing the typical thickened concentric ring appearance.

View larger version (130K): [in a new window]   Figure 9. Carcinoma of the rectum, which has disseminated within the abdominal cavity. Contrast study of the small bowel (a) demonstrates angulation and narrowing of a number of jejunal loops, an appearance confirmed by the CT image (b), which also shows the loculated ascites surrounding these loops.

View larger version (66K): [in a new window]   Figure 10. Haematogeneous spread of breast carcinoma to the colon causing the typical crenated appearance along the superior margin of the transverse colon as shown on the barium enema (a). The CT image (b) clearly shows the submucosal mass in this region (arrows).

View larger version (67K): [in a new window]   Figure 11. Small bowel obstruction in an elderly female. The more cranial image (a) demonstrates multiple dilated loops of small bowel with characteristic air–fluid levels. The image through the lower pelvis (b) demonstrates the obturator hernia on the right, which was the cause of the obstruction. Further questioning revealed a history of pain passing down the inside of the right leg.

View larger version (76K): [in a new window]   Figure 12. Partial small bowel obstruction with prominent dilatation of a mid abdominal small bowel loop, but also fluid in the caecum and descending colon (a). The more caudal image through the pelvis (b) demonstrates the obstruction as being due to diverticular disease of the sigmoid (arrowheads) causing a pelvic abscess (arrows) within which the small bowel had become entangled.