Computed tomography of the stomach and intestines
Last reviewed: 23.04.2024
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Computed tomography of the stomach and small intestine
To study the stomach after IV injection of the buscopan, the patient is given a drink of water as a hypodense contrast agent. However, with a traditional CT scan, a small tumor can be overlooked. Therefore, in addition to CT, endoscopy and endosonography are necessary.
Significant local wall thickening, which appears in stomach cancer, is usually clearly visible. In the case of diffuse wall thickening, the differential diagnosis also includes lymphoma, leiomyoma and stomach leiomyosarcoma. The presence of gas in the abdominal cavity is a sign of perforation, which is possible with peptic ulcer or ulcerative form of stomach cancer.
Inflammatory bowel disease
The entire small and large intestine is assessed for wall thickness and infiltration of surrounding fatty tissue. Ulcerative-necrotic colitis Crohn's disease is characterized by thickening of the affected intestinal walls. The layers of the intestinal wall become visible. The syndrome of disseminated intravascular coagulation or increased anticoagulation after taking warfarin can cause diffuse bleeding into the intestinal wall with its thickening. Differential diagnosis includes ischemia due to pathological changes in the corresponding segment of mesenteric vessels, for example, the walls of the colon as a result of progressive atherosclerosis or embolism. Therefore, you should be convinced of a homogeneous enhancement of the mesenteric vessels and the intestinal wall after intravenous administration of contrast medium.
Computed tomography of large intestine
In elderly patients, diverticulosis of the descending colon and sigmoid colon is common. In this case, the acute acute diverticulitis, which is characterized by indistinctness of the intestinal wall and edema of the infiltrated surrounding fatty tissue of the mesentery, is of clinical importance.
Thickening of the wall of the colon with the development of malignant neoplasm can not always be clearly distinguished from similar changes in colitis - in both cases the surrounding fatty tissue is involved in the process. If the cause of pathological changes in the colon is not detected, it is always necessary to examine the liver in order to detect metastases.
With a left-sided hemicolectomy, a temporary colostomy can be applied. If a sigmoid colon develops a malignant neoplasm or diverticulitis with perforation - remove the sigmoid colon with the formation of sigmostoma. When resecting the rectum impose a permanent colostomy. Carcinoid of the small intestine can simulate colon cancer.
Intestinal obstruction
Horizontal fluid levels in the lumen of the gut, atony and expansion of the intestinal loops are characteristic signs of intestinal obstruction. If the intestine is swollen, obstruction can be suspected even if the patient's stomach is visually inspected or the topogram is visualized. If only the small intestine is involved in the process, the most likely is mechanical obstruction due to the adhesion process. Also, the cause of small intestinal obstruction can be the concrements of the biliary tract. This is possible with cholecystitis with the formation of the cholelithiasis and small intestine fistula and the ingress of the calculus from the gallbladder and the small intestine. Moving along the intestine and reaching the distal, narrower part of the small intestine, the concrement can close its lumen.
Mechanical obstruction of the colon leads to a similar expansion of the intestinal lumen with fluid levels. To determine the cause of intestinal obstruction, it is necessary to examine the entire large intestine. In this case, seek obstruction or narrowing of the lumen tumor or inflammatory process.
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