Clinical Significance of Poor CT Enhancement of the Thickened Small-Bowel Wall in Patients with Acute Abdominal Pain

Our purpose was to compare clinical outcomes in patients with acute abdominal pain and inner-layer enhancement of a thickened small-bowel wall, as shown on CT, with outcomes in similar patients without such enhancement. We retrospectively studied outcomes in 126 patients with acute abdominal pain and small-bowel wall thickening on CT: 84 with inner-layer enhancement and 42 without this enhancement. We compared the surgical, small-bowel resection, small-bowel necrosis, and mortality rates between the two groups using the chi-square test. Among the 42 patients without inner-layer enhancement, 32 (76%) underwent an operation, 27 (64%) received segmental small-bowel resection, 26 (62%) had small-bowel necrosis, and seven (17%) died. All of these proportions were significantly higher (p < 0.01) than the corresponding rates-34 (40%), nine (11%), five (6%), and two (2%), respectively-in the 84 patients with inner-layer enhancement. All 31 patients with necrotic small bowel had pathologic evidence of ischemic necrosis involving the mucosa. Among patients with acute abdominal pain, those whose CT scans did not show inner-layer enhancement of a thickened small-bowel wall were more prone to undergo surgery and small-bowel resection and were more likely to have small-bowel necrosis than those with such enhancement. Poor inner-layer enhancement on CT might be consistent with sloughed or necrotic mucosa, as observed on pathology.