Computed tomography of the stomach and intestines

Computed tomography of the stomach and small intestine

To examine the stomach after intravenous administration of buscopan, the patient is given water to drink as a hypodense contrast agent. However, a small tumor may not be seen with traditional CT scanning. Therefore, in addition to CT, it is necessary to conduct an endoscopic examination and endosonography.

Significant local wall thickening, which occurs in gastric cancer, is usually clearly visible. In case of diffuse wall thickening, the differential diagnosis also includes lymphoma, leiomyoma and leiomyosarcoma of the stomach. The presence of gas in the abdominal cavity is a sign of perforation, which is possible in peptic ulcer disease or ulcerative form of gastric cancer.

Inflammatory bowel disease

The entire small and large intestine is assessed for wall thickness and infiltration of the surrounding fatty tissue. Ulcerative necrotic colitis and Crohn's disease are characterized by thickening of the affected intestinal walls. In this case, the layers of the intestinal wall become visible. Disseminated intravascular coagulation syndrome or increased anticoagulation after taking warfarin can cause diffuse bleeding into the intestinal wall with its thickening. The differential diagnosis includes ischemia due to pathological changes in the corresponding segment of the mesenteric vessels, for example, the colonic wall due to progressive atherosclerosis or embolism. Therefore, you should ensure homogeneous enhancement of the mesenteric vessels and intestinal wall after intravenous administration of contrast agent.

CT scan of the colon

Diverticulosis of the descending colon and sigmoid colon is common in elderly patients. In this case, acute diverticulitis, which is characterized by the blurring of the intestinal wall and edema of the infiltrated surrounding fatty tissue of the mesentery, is of clinical significance.

Thickening of the colon wall during the development of a malignant neoplasm cannot 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 identified, it is always necessary to examine the liver in order to detect metastases.

In case of left-sided hemicolectomy, a temporary colostomy may be performed. If a malignant neoplasm or diverticulitis with perforation develops in the sigmoid colon, the sigmoid colon is removed and a sigmoidostomy is formed. In case of rectal resection, a permanent colostomy is performed. Small intestinal carcinoid may simulate colon cancer.

Intestinal obstruction

Horizontal fluid levels in the intestinal lumen, atony and dilation of intestinal loops are characteristic signs of intestinal obstruction. In case of intestinal distension, obstruction can be suspected already during visual examination of the patient's abdomen or by topogram. If only the small intestine is involved in the process, mechanical obstruction due to adhesions is most likely. Also, small intestinal obstruction can be caused by bile duct stones. This is possible with cholecystitis with the formation of a gallbladder-small intestinal fistula and the entry of a stone from the gallbladder into the small intestine. Moving along the intestine and reaching the distal, narrower part of the small intestine, the stone can block its lumen.

Mechanical obstruction of the colon results in a similar dilation of the intestinal lumen with fluid levels. To identify the cause of intestinal obstruction, the entire colon must be examined. In this case, they look for obstruction or narrowing of the lumen by a tumor or inflammatory process.

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