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Frequency and CT Patterns of Bowel Wall Thickening Proximal to Cancer of the Colon

¹ Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900.
² Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900.
³ Department of Radiology, Wilford Hall Medical Center, 759 MDTS/MTR, 2200 Bergquist Dr., Ste. 1, Lackland AFB, TX 78236-5300.
⁴ Department of Pathology/MTLP, Wilford Hall Medical Center, Lackland AFB, TX, 78236.

OBJECTIVE. This study was performed to determine the frequency and patterns of colon wall thickening seen on CT of patients with adenocarcinoma of the colon.

MATERIALS AND METHODS. Preoperative abdominal and pelvic CT scans of 185 patients with surgically proven adenocarcinoma of the colon were retrospectively evaluated by three abdominal radiologists for the presence of colon obstruction and colon wall thickening proximal to the colon adenocarcinoma. The distributions and patterns of colon wall thickening were categorized by consensus. CT findings were compared with pathologic findings. Fisher's exact test was used to determine the statistical significance of any associations.

RESULTS. Of 185 patients, CT findings of 20 (10.8%) showed colon wall thickening. Of these, the adenocarcinoma obstructed the colon in 19 patients (p < 0.01). Colon obstruction was partial in 10 patients (53%) and complete in nine (47%). Colon wall thickening was contiguous to the tumor in 14 (70%) patients and noncontiguous in six (30%). Segmental and pancolonic, patchy and diffuse, and dependent and nondependent colon wall thickening was observed in 10 patients (50%) in each category. Associated small-bowel wall thickening was shown in 10 (50%) of the 20 patients. Pathologic examination showed colon wall thickening to be due to edema in all cases.

CONCLUSION. Colon wall edema can occur proximal to colon adenocarcinoma, is almost always associated with colon obstruction, and is predominantly contiguous with the obstructing adenocarcinoma.

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