Spiral CT of the abdomen after distention of small bowel loops with transparent enema in patients with Crohn's disease

BACKGROUND

[corrected] To evaluate the capability of a computed tomographic (CT) technique that combines distention of the small bowel loops with a transparent enema with contrast-enhanced spiral CT of the abdomen in patients with Crohn's disease.

METHODS

We evaluated the abdomen with spiral CT after distention of the small bowel loops with a transparent enema of methylcellulose in 40 patients consecutively referred for radiologic evaluation of Crohn's disease of the small bowel. Fluid was infused through a nasojejunal catheter with a peristaltic pump. Ultrasonography was used to prevent bowel overdistention and detect arrival of methylcellulose to the cecum. Contrast-enhanced spiral CT of the abdomen was then performed, and the degree of contrast enhancement and the thickness of the walls of the involved loops were evaluated. A series of 10 patients with retrograde distention of the last ileal loop from large bowel water enema was used as a control. The results of the CT were compared with those of conventional radiographic small bowel studies.

RESULTS

The normal small bowel wall was 1.9-2.5 mm thick (mean = 2. 1 mm); density values of the normal enhanced wall varied between 25 and 60 HU (mean = 32 HU) and presented a homogeneous structure. Bowel segments involved by the disease were 4-12.5 mm thick (mean = 9.2 mm), had density values of 75-150 HU (mean = 105 HU), and showed a multilayered appearance. Compared with conventional radiography, CT detected longer lesions or additional segments involved by the disease process in 14 cases, 11 additional fistulas, two abscesses, and mesenteric changes in 21 cases.

CONCLUSIONS

The small bowel CT enema technique provides good results in the study of patients with Crohn's disease and can be used to evaluate patients with advanced lesions.

Radiology of adjustable silicone gastric banding for morbid obesity

We reviewed the radiological findings in 45 morbidly obese patients (weight range 80-129 kg; mean 95.7 kg) after gastric restriction surgery with adjustable silicone gastric banding (ASBG) according to the Kuzmak technique. Radiographic studies of the stomach were performed before, and at 4 and 12 months after surgery; symptomatic patients underwent additional studies when needed. Patients were evaluated using both liquid barium and a solid opaque meal to assess post-operative gastric morphology as well as emptying time of the proximal gastric pouch. 27 patients had a normal clinical course. Variation of the calibre of the silicone band under radiographic guidance was required in 12 of these patients, based on dilatation of the proximal pouch, variation of the stomal calibre from operative values, or an emptying time longer than 30 min. All these problems disappeared after the adjustment manoeuvres. 18 patients had complications, of which five had stomal stenosis which could not be managed through simple deflation of the band; two had posterior bending and dilatation of the proximal pouch; four had gastritis and oesophagitis; six had infection of the inflatable reservoir; one had cranial displacement of the band, and two had migration of the band into the stomach. Removal of the gastric band was necessary in 11 cases, and removal of the reservoir alone had to be performed in three additional patients. Radiology plays an important role in evaluating complications after gastric restriction surgery. Knowing the variety of findings enables accurate treatment planning and follow-up of these patients.