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Sonographic Findings in Ischemic Colitis in 58 Patients

¹ Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Ave., Valencia 46017, Spain.
² Department of Gastroenterology, Hospital Universitario Dr. Peset, Valencia 46017, Spain.

View larger version (119K): [in a new window]   Fig. 1A. —72-year-old man with transient ischemia. Transverse (A) and longitudinal (B) sonograms reveal marked thickening of left colon (D) with normal stratification. Diagnosis was confirmed at colonoscopy. Patient showed favorable response to conservative treatment.

View larger version (131K): [in a new window]   Fig. 1B. —72-year-old man with transient ischemia. Transverse (A) and longitudinal (B) sonograms reveal marked thickening of left colon (D) with normal stratification. Diagnosis was confirmed at colonoscopy. Patient showed favorable response to conservative treatment.

View larger version (109K): [in a new window]   Fig. 2. —Ischemic colitis in 75-year-old man with abdominal pain, rectal bleeding, and diarrhea. Sonogram shows nonstratified thickening of bowel wall of descending and sigmoid colons (S) and altered pericolic fat (white arrows). Barely visible color Doppler flow (only one color pixel) is seen (black arrow). Also note vascular engorgement (arrowheads). Resistive index value was 1 (not shown). Colonoscopy showed patchy areas of mural necrosis. Left colectomy performed 3 days later revealed transmural necrosis.

View larger version (139K): [in a new window]   Fig. 3A. —Ischemic colitis of left colon in 65-year-old man with left lower quadrant pain and rectal bleeding. Sonography showed segmental colitis involving splenic flexure and descending and sigmoid colons (S). Transverse sonogram shows thickening of sigmoid colon wall, with barely visible color Doppler flow (shown here in black-and-white, arrow) (only one color pixel).

View larger version (99K): [in a new window]   Fig. 3B. —Ischemic colitis of left colon in 65-year-old man with left lower quadrant pain and rectal bleeding. Sonography showed segmental colitis involving splenic flexure and descending and sigmoid colons (S). Duplex Doppler sonogram confirmed arterial flow in colon wall (resistive index, 0.69).

View larger version (134K): [in a new window]   Fig. 3C. —Ischemic colitis of left colon in 65-year-old man with left lower quadrant pain and rectal bleeding. Sonography showed segmental colitis involving splenic flexure and descending and sigmoid colons (S). Longitudinal sonogram shows preservation of wall stratification, with submucosal (hyperechoic) layer clearly visible. Diagnosis was confirmed at colonoscopy, and ischemia resolved without complications after conservative treatment.

View larger version (149K): [in a new window]   Fig. 4A. —Ischemic colitis in 76-year-old man with acute right lower quadrant pain, diarrhea, and elevated WBC. Sonogram shows hypoechoic thickening of wall of right colon, with stratification preserved, and normal pericolic fat. Color Doppler flow was barely detected (not shown). CA = colon ascending.

View larger version (145K): [in a new window]   Fig. 4B. —Ischemic colitis in 76-year-old man with acute right lower quadrant pain, diarrhea, and elevated WBC. Sonogram shows air in intrahepatic branches of right portal vein (arrows). Diagnosis was confirmed at colonoscopy and biopsy. Sonography performed 3 days later showed thinning of colonic wall and absence of air in portal branches (not shown). Ischemic process resolved without complications after conservative treatment.

View larger version (143K): [in a new window]   Fig. 5A. —Transient ischemic colitis in 74-year-old woman with diffuse abdominal pain, diarrhea, rectal bleeding, and leukocytosis (18 x 103/µL). Transvaginal sonogram reveals involvement of rectum (R) and sigmoid colon (S) and marked wall thickening. Bowel wall is stratified in rectum but is nonstratified in sigmoid colon.

View larger version (133K): [in a new window]   Fig. 5B. —Transient ischemic colitis in 74-year-old woman with diffuse abdominal pain, diarrhea, rectal bleeding, and leukocytosis (18 x 103/µL). Transvaginal sonogram shows circumferential wall thickening of distal sigmoid colon (S) with numerous color pixels scattered throughout bowel wall (color Doppler flow was considered readily visible). Diagnosis was confirmed at colonoscopy and biopsy. Ischemia resolved without complications.

View larger version (123K): [in a new window]   Fig. 6A. —Ischemic colitis in 74-year-old woman who presented with abdominal pain, rectal bleeding, and elevated WBC. Sonogram shows marked thickening of sigmoid colon (S) and rectum. Bowel wall is stratified and color Doppler flow was barely detected (not shown). Diagnosis was confirmed at colonoscopy. Calipers show thickness of sigmoid colon.

View larger version (119K): [in a new window]   Fig. 6B. —Ischemic colitis in 74-year-old woman who presented with abdominal pain, rectal bleeding, and elevated WBC. Sonogram obtained 6 days after A shows almost complete resolution of process and nearly normal sigmoid colon wall (S) coincidental with clinical improvement. Calipers show thickness of sigmoid colon.

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