NON-ENHANCEMENT OF THE THICKENED SMALL BOWEL WALL ON CT: CAN INDICATE THE CLINICAL OUTCOME IN PATIENTS WITH ACUTE ABDOMINAL PAIN?
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Purpose: Our purpose was to determine whether absent inner layer enhancement of a thickened small-bowel wall on computed tomography (CT) can indicate the clinical outcome in patients with acute abdominal pain. Materials and methods: In 70 patients with acute abdominal pain and thickened small-bowel wall on CT scans, we compared the clinical outcomes in 43 patients with inner-layer enhancement of the thickened small-bowel wall (group A) with 27 patients without this enhancement (group B). We compared the rates of surgical intervention, small-bowel resection, small-bowel necrosis, and mortality between the two groups. Results: Among the 27 patients without inner-layer enhancement, 22 (81.4%) underwent surgical intervention, 17(63%) underwent segmental small-bowel resection, 16(59.2%) had small-bowel necrosis, and 5 (18.5%) died compared to 25 (58%), 5 (11.6%), 3 (6.9%) and one (2.3%) respectively in the 43 patients with inner-layer enhancement. Thus, the rates for surgical intervention, bowel resection, bowel necrosis and death were significantly higher in patients without inner-layer enhancement than the respective rates in those with inner-layer enhancement (p<0.01). Conclusion: Patients without inner-layer enhancement -of the thickened small bowel wall on CT have clinical outcomes worse than that of patients with this enhancement; their worse outcomes include significantly higher probabilities of surgery, segmental small-bowel resection, small-bowel necrosis, and mortality. Thus, non-enhancement of the inner layer of the thickened small-bowel wall on CT scan in patients with acute abdominal pain may indicate a worse clinical outcome. Key Words: Inner-layer, CT, small bowel.