Berritto Daniela, Iacobellis Francesca, Mazzei Maria Antonietta, Volterrani Luca, Guglielmi Giuseppe, Brunese Luca, Grassi Roberto
1 Department of Radiology, Private Hospital "Villa Dei Fiori" S.r.l. Accredited to National Health System, Acerra (NA), Italy.
2 Department of Radiology, Second University of Napoli, Napoli, Italy.
Br J Radiol. 2016;89(1061):20150821. doi: 10.1259/bjr.20150821. Epub 2016 Mar 23.
Ischemic colitis (IC) is the most common vascular disorder of the gastrointestinal tract with a reported incidence of 6.1-44 cases/100,000 person years with confirmatory histopathology. However, the true incidence of IC poses some difficulty, and even vigilant clinicians with patients at high risk often miss the diagnosis, since clinical presentation is non-specific or could have a mild transient nature. Detection of IC results is crucial to plan the correct therapeutic approach and reduce the reported mortality rate (4-12%). Diagnosis of IC is based on a combination of clinical suspicion, radiological, endoscopic and histological findings. Some consider colonoscopy as a diagnostic test of choice; however, preparation is required and it is not without risk, above all in patients who are severely ill. There are two manifestations of vascular colonic insult: ischaemic and reperfusive. The first one occurs above all during ischaemic/non-occlusive mesenteric ischaemia; in this case, the colonic wall appears thinned with dilated lumen and fluid appears in the paracolic space. When reperfusion occurs, the large bowel wall appears thickened and stratified, because of subepithelial oedema and/or haemorrhage, with consequent lumen calibre reduction. Shaggy contour of the involved intestine and misty mesentery are associated with the pericolic fluid. The pericolic fluid results are a crucial finding for IC diagnosis since its evidence suggests the presence of an ongoing damage thus focusing the attention on other pathological aspects which could be otherwise misdiagnosed, such as thinned or thickened colonic wall. Moreover, the pericolic fluid may increase or decrease, depending on the evolution of the ischaemic damage, suggesting the decision of medical or surgical treatment. Radiologists should not forget the hypothesis of IC, being aware that multidetector CT could be sufficient to suggest the diagnosis of IC, allowing for early identification and grading definition, and in a short-term follow-up, discriminating patients who need urgent surgery from patients in whom medical treatment and follow-up can be proposed.
缺血性结肠炎（IC）是胃肠道最常见的血管性疾病，经组织病理学确诊的发病率为每10万人年6.1 - 44例。然而，IC的真实发病率难以确定，即使是对高危患者保持警惕的临床医生也常常漏诊，因为其临床表现不具特异性或可能具有轻度短暂性。IC结果的检测对于规划正确的治疗方法和降低报告的死亡率（4% - 12%）至关重要。IC的诊断基于临床怀疑、影像学、内镜和组织学检查结果的综合判断。一些人认为结肠镜检查是首选的诊断方法；然而，需要进行肠道准备，且并非没有风险，尤其是对重症患者而言。结肠血管损伤有两种表现形式：缺血性和再灌注性。前者主要发生在缺血性/非闭塞性肠系膜缺血期间；在这种情况下，结肠壁变薄，管腔扩张，结肠旁间隙出现液体。当发生再灌注时，由于上皮下水肿和/或出血，大肠壁增厚且分层，导致管腔口径减小。受累肠段的轮廓不规则和肠系膜模糊与结肠旁液体有关。结肠旁液体的出现是IC诊断的关键发现，因为它表明存在持续的损伤，从而将注意力集中在其他可能被误诊的病理方面，如结肠壁变薄或增厚。此外，结肠旁液体可能会根据缺血损伤的进展而增加或减少，这提示了医疗或手术治疗的决策。放射科医生不应忘记IC的可能性，应意识到多排CT足以提示IC的诊断，能够实现早期识别和分级定义，并且在短期随访中，区分需要紧急手术的患者和可建议进行药物治疗及随访的患者。
