E. Radice

Prevalence and clinical significance of sonographic evidence of mesenteric fat alterations in Crohn's disease

Background: Mesenteric adipose tissue hypertrophy is a frequent sonographic finding in Crohns disease (CD). This study assessed its sonographic prevalence, the correlation with the degree of clinical or biochemical activity of the disease, and its impact on disease outcome in CD patients. Methods: In all, 185 consecutive CD patients underwent bowel ultrasound to assess the presence of mesenteric fat tissue alteration as well as thickness and echopattern of the bowel wall, site and extent of CD, and presence of stenosis, fistulas, and abscesses. Clinical and biochemical parameters of disease activity were also assessed. Multiple logistic regression analysis was used to identify variables related to mesenteric adipose tissue alteration. Results: Mesenteric adipose tissue alteration, detected in 88 (47.6%) patients, showed a significant correlation both with clinical and biochemical CD activity and with internal fistulas, bowel wall thickness, and length of thickened bowel wall. Logistic regression analysis showed that internal fistulas (odds ratio [OR] = 13.5), thickened bowel wall (OR = 7.6), C‐reactive protein (OR = 6.1), CD Activity Index (CDAI) (OR = 3.1), and length of diseased bowel walls (OR = 2.6) were significantly associated with mesenteric adipose tissue alteration. Of the 111 patients with quiescent CD, 22 showed mesenteric adipose tissue hypertrophy. These patients did not show increased risk of relapse compared with quiescent patients without mesenteric fat alteration. Conclusions: Mesenteric adipose tissue alteration is correlated with biochemical and clinical activity of CD and with internal fistulas and increased bowel wall thickness. In quiescent CD, mesenteric hypertrophy does not appear to be a risk factor of relapse.

Hydrosonography of the gastrointestinal tract.

OBJECTIVE Bowel sonography has become accepted as a useful tool in several gastrointestinal disorders. Filling of the gut with echo-poor liquids has been proposed to achieve a detailed evaluation of the bowel. This article refers to a review made concerning the benefits and limits of hydrosonography of the gastrointestinal tract. CONCLUSION The use of a luminal contrast agent in bowel sonography may improve results but should be adopted on a case-by-case basis, according to the clinical context and the experience of the sonologist.

Crohn’s Disease

Fistulization is one of the major troublesome issues of Crohn’s disease (CD). Fistulas are abnormal tracts formed between the gut and the skin, between the gut and an abscess cavity, or between the gut and other hollow structures, including the vagina. Fistulas arises from ulcers that progress to deep transmural fissures which then eventually penetrate other structures or open into another organ. They are classified as internal or external depending on where they terminate. Internal fistulas are enteroenteric, gastrocolic, enterovaginal, and enterovescical; external fistulas are enterocutaneous, colocutaneous, or perianal.

Referrals for bowel ultrasound in clinical practice: A survey in 12 nationwide centres in Italy

BACKGROUND The value of ultrasound (US) in assessing gastrointestinal diseases is well documented, but its demand in clinical practice is unknown. This survey evaluated the demand for bowel US in Italy. METHODS Twelve sonographers of the Gastroenterology Section of the Italian Society of Ultrasound participated in a 1-month survey; they compiled a questionnaire assessing total number of patients referred for abdominal US and for gastrointestinal tract US, type of referring physician, indications and results of examinations. RESULTS The survey included 2424 examinations, 586 of which (24%) investigated the gastrointestinal tract: 280 for signs or symptoms and 268 for follow-up of pre-existing gastrointestinal diseases. Referring physicians were mainly gastroenterologists (78%) and general practitioners (13%). Organic lesions were found or suspected in 292 examinations. CONCLUSIONS Bowel US is used in Italy in routine practice, mainly by gastroenterologists and general practitioners, both for follow-up of pre-existing diseases and for gastrointestinal complaints.

Ultrasound Anatomy of the Anorectal Region

Imaging of the rectum, anorectal junction, and surrounding tissues has always been challenging, including technically, especially when conventional radiological techniques such as computed tomography (CT) and barium studies are used. However, during the past few decades, magnetic resonance imaging (MRI) and sonography have significantly improved visualization of the anorectum and of perianal diseases.

An infrequent cause of acute left lower quadrant abdominal pain

A 65-year-old male patient referred with acute abdominal pain in the left lower quadrant and a low grade fever (38°C) was admitted to the surgical emergency department of our institution. He was haemodynamically stable. His bowel movements were completely normal. …