Nonischemic Colitis

  • Philippe Soyer
  • Mourad Boudiaf
  • Youcef Guerrache
  • Christine Hoeffel
  • Xavier Dray
  • Patrice Taourel
Part of the Medical Radiology book series (MEDRAD)


Many patients with acute colitis present with abdominal pain or other nonspecific symptoms. In these patients, multidetector row CT is often used as the initial diagnostic test, which plays a pivotal role. This imaging technique can demonstrate inflammatory changes in the colonic wall, determine the extent of the disease, and detect the potential complications. In addition, multidetector row CT helps identify myriad extracolonic conditions that are responsible for the nonspecific symptoms should the patients have a cause of symptoms other than colitis. In most cases, the specific cause of colitis is determined on the basis of the results of clinical examination, laboratory tests, optical colonoscopy, and colonic biopsy. However, in equivocal cases or emergency situations, multidetector row CT findings help narrow the differential diagnosis. Many multidetector row CT features or patterns are helpful in distinguishing between the various types of colitis. They include the degree of wall thickening and colonic edema, the extent and location of the disease, extraluminal manifestations, and types of complication. Multidetector row CT has a critical role in determining the most appropriate therapeutic approach in a substantial number of cases.


Ulcerative Colitis Iodinate Contrast Material Colonic Wall Pseudomembranous Colitis Optical Colonoscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adams GW, Rauch RF, Kelvin FM, Silverman PM, Korobkin M (1985) CT detection of typhlitis. J Comput Assist Tomogr 9:363–365PubMedCrossRefGoogle Scholar
  2. Balthazar EJ (1991) CT of the gastrointestinal tract: principles and interpretation. AJR Am J Roentgenol 156:23–32PubMedGoogle Scholar
  3. Boudiaf M, Zidi SH, Soyer P, Lavergne-Slove A, Kardache M, Logeay O, Rymer R (1998) Tuberculous colitis mimicking Crohn’s disease: utility of computed tomography in the differentiation. Eur Radiol 8:1221–1223PubMedCrossRefGoogle Scholar
  4. Boudiaf M, Soyer P, Pelage JP, Kardache M, Nemeth J, Dufresne AC, Rymer R (2000) CT of radiation-induced injury of the gastrointestinal tract: spectrum of findings with barium studies correlation. Eur Radiol 10:920–925PubMedCrossRefGoogle Scholar
  5. Bradley SJ, Weaver DW, Maxwell NP, Bouwman DL (1988) Surgical management of pseudomembranous colitis. Am Surg 54:329–332PubMedGoogle Scholar
  6. Cao J, Liu WJ, Xu XY, Zou XP (2010) Endoscopic findings and clinicopathologic characteristics of colonic schistosomiasis: a report of 46 cases. World J Gastroenterol 16:723–727PubMedCrossRefGoogle Scholar
  7. Casola G, vanSonnenberg E, Neff CC, Saba RM, Withers C, Emarine CW et al (1987) Abscesses in Crohn disease: percutaneous drainage. Radiology 163:19–22PubMedGoogle Scholar
  8. Choi D, Jin Lee S, Ah Cho Y et al (2003) Bowel wall thickening in patients with Crohn’s disease: CT patterns and correlation with inflammatory activity. Clin Radiol 58:68–74PubMedCrossRefGoogle Scholar
  9. Connor R, Jones B, Fishman EK, Siegelman SS (1984) Pneumatosis intestinalis: role of computed tomography in diagnosis and management. J Comput Assist Tomogr 8:269–275PubMedGoogle Scholar
  10. Da Ines D, Petitcolin V, Lannareix W, Essamet W, Tournilhac O, Garcier JM (2010) CT imaging features of colitis in neutropenic patients. J Radiol 91:675–686PubMedCrossRefGoogle Scholar
  11. Fishman EK, Wolf EJ, Jones B, Bayless TM, Siegelman SS (1987) CT evaluation of Crohn’s disease: effect on patient management. AJR Am J Roentgenol 148:537–540PubMedGoogle Scholar
  12. Fishman EK, Kavuru M, Jones B (1991) Pseudomembranous colitis: CT evaluation of 26 cases. Radiology 180:57–60PubMedGoogle Scholar
  13. Frager DH, Goldman M, Beneventano TC (1983) Computed tomography in Crohn disease. J Comput Assist Tomogr 7:819–824PubMedCrossRefGoogle Scholar
  14. Frager DH, Frager JD, Wolf EL, Rand LG, St Onge G, Mitsudo S, Bodner L, Brandt LJ, Beneventano TC (1986) Cytomegalovirus colitis in acquired immune deficiency syndrome: radiologic spectrum. Gastrointest Radiol 11:241–246PubMedCrossRefGoogle Scholar
  15. Frick MP, Maile CW, Crass JR, Goldberg ME, Delaney JP (1984) Computed tomography of neutropenic colitis. AJR Am J Roentgenol 143:763–765PubMedGoogle Scholar
  16. Frommhold W, Hubener KH (1981) The role of computerized tomography in the after care of patients suffering from carcinoma of the rectum. J Comput Assist Tomogr 5:161–168CrossRefGoogle Scholar
  17. Funayama Y, Sasaki I, Naito H et al (1996) Psoas abscess complicating Crohn’s disease: report of two cases. Surg Today 26:345–348PubMedCrossRefGoogle Scholar
  18. Furukawa A, Saotome T, Yamasaki M et al (2004) Cross-sectional imaging in Crohn disease. Radiographics 24:689–702PubMedCrossRefGoogle Scholar
  19. Gayer G, Apter S, Zissin R (2002) Typhlitis as a rare cause of a psoas abscess. Abdom Imaging 27:600–602PubMedCrossRefGoogle Scholar
  20. Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN (1983) The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. Q J Med 52:40–53PubMedGoogle Scholar
  21. Gomez L, Martino R, Rolston KV (1998) Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Infest Dis 27:695–699CrossRefGoogle Scholar
  22. Gore RM, Marn CS, Kirby DF, Vogelzang RL, Neiman HL (1984) CT findings in ulcerative, granulomatous, and indeterminate colitis. AJR Am J Roentgenol 143:279–284PubMedGoogle Scholar
  23. Gore RM, Balthazar EJ, Ghahremani GG, Miller FH (1996) CT features of ulcerative colitis and Crohn’s disease. AJR Am J Roentgenol 167:3–15PubMedGoogle Scholar
  24. Gossios KJ, Tsianos EV (1997) Crohn disease: CT findings after treatment. Abdom Imaging 22:160–163PubMedCrossRefGoogle Scholar
  25. Herlinger H, Furth EE, Rubesin SE (1998) Fibrofatty proliferation of the mesentery in Crohn disease. Abdom Imaging 23:446–468PubMedCrossRefGoogle Scholar
  26. Hoeffel C, Crema MD, Belkacem A, Azizi L, Lewin M, Arrivé L, Tubiana JM (2006) Multi-detector row CT: spectrum of diseases involving the ileocecal area. Radiographics 26:1373–1790PubMedCrossRefGoogle Scholar
  27. Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. Radiographics 20:399–418PubMedGoogle Scholar
  28. Imbriaco M, Balthazar EJ (2001) Toxic megacolon: role of CT in evaluation and detection of complications. Clin Imaging 25:349–354PubMedCrossRefGoogle Scholar
  29. Jafri SF, Marshall LB (1996) Ascites associated with antibiotic-associated pseudomembranous colitis. South Med J 89:1014–1017PubMedCrossRefGoogle Scholar
  30. Jobe BA, Grasley A, Deveney KE, Deveney CW, Sheppard BC (1995) Clostridium difficile colitis: an increasing hospital-acquired illness. Am J Surg 169:480–483PubMedCrossRefGoogle Scholar
  31. Jones B, Fishman EK, Hamilton SR et al (1986a) Submucosal accumulation of fat in inflammatory bowel disease: CT/pathologic correlation. J Comput Assist Tomogr 10:759–763PubMedCrossRefGoogle Scholar
  32. Jones B, Fishman EK, Kramer SS (1986b) Computed tomography of gastrointestinal inflammation after bone marrow transplantation. AJR Am J Roentgenol 146:691–695PubMedGoogle Scholar
  33. Kalantari BN, Mortelé KJ, Cantisani V (2003) CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults. AJR Am J Roentgenol 181:1621–1625PubMedGoogle Scholar
  34. Kalra MK, Maher MM, Toth TL, Schmidt B, Westerman BL, Morgan HT et al (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233:649–657PubMedCrossRefGoogle Scholar
  35. Kawamoto S, Horton KM, Fishman EK (1999) Pseudomembranous colitis: can CT predict which patients will need surgical intervention? J Comput Assist Tomogr 23:79–85PubMedCrossRefGoogle Scholar
  36. Kelly CP, Pothoulakis C, LaMont JT (1994) Clostridium difficile colitis. N Engl J Med 330:257–262PubMedCrossRefGoogle Scholar
  37. Kimose HH, Fischer L, Spjeldmaes N, Wara P (1989) Late radiation injury of the colon and rectum: surgical management and outcome. Dis Colon Rectum 32:684–689PubMedCrossRefGoogle Scholar
  38. Kirkpatrick ID, Greenberg HM (2001) Evaluating the CT diagnosis of Clostridium difficile colitis: should CT guide therapy? AJR Am J Roentgenol 176:635–639PubMedGoogle Scholar
  39. Kirkpatrick ID, Greenberg HM (2003) Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT. Radiology 226:668–674PubMedCrossRefGoogle Scholar
  40. Klingler PJ, Metzger PP, Seelig MH, Pettit PD, Knudsen JM, Alvarez SA (2000) Clostridium difficile infection: risk factors, medical and surgical management. Dig Dis 18:147–160PubMedCrossRefGoogle Scholar
  41. Kralovich KA, Sacksner J, Karmy-Jones RA, Eggenberger JC (1997) Pseudomembranous colitis with associated fulminant ileitis in the defunctionalized limb of a jejunalileal bypass: report of a case. Dis Colon Rectum 40:622–624PubMedCrossRefGoogle Scholar
  42. Kuehne SA, Cartman ST, Heap JT, Kelly ML, Cockayne A, Minton NP (2010) The role of toxin A and toxin B in Clostridium difficile infection. Nature 467:711–773Google Scholar
  43. Latella G, Vernia P, Viscido A et al (2002) GI distension in severe ulcerative colitis. Am J Gastroenterol 97:1169–1175PubMedCrossRefGoogle Scholar
  44. Lee SS, Ha HK, Yang SK et al (2002) CT of prominent pericolic or perienteric vasculature in patients with Crohn’s disease: correlation with clinical disease activity and findings on barium studies. AJR Am J Roentgenol 179:1029–1036PubMedGoogle Scholar
  45. Lefèvre A, Soyer P, Vahedi K, Guerrache Y, Bellucci S, Gault V, Boudiaf M (2011) Multiple intra-abdominal venous thrombosis in ulcerative colitis: role of MDCT for detection. Clin Imaging 35:68–72Google Scholar
  46. Ma LD, Jones B, Lazenby AJ, Douglas T, Bulte JW (1994) Persistent oral contrast agent lining the intestine in severe mucosal disease: elucidation of radiographic appearance. Radiology 191:747–749PubMedGoogle Scholar
  47. Macari M, Balthazar EJ (2001) CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 176:1105–1116PubMedGoogle Scholar
  48. Macari M, Balthazar EJ, Megibow AJ (1999) The accordion sign at CT: a nonspecific finding in patients with colonic edema. Radiology 211:743–746PubMedGoogle Scholar
  49. Makanjuola D (1998) Is it Crohn’s disease or intestinal tuberculosis? CT analysis. Eur J Radiol 28:55–61PubMedCrossRefGoogle Scholar
  50. McDonald JB, Middleton PJ (1976) Tuberculosis of the colon simulating carcinoma. Radiology 118:293–294PubMedGoogle Scholar
  51. Merine D, Fishman EK, Jones B (1987a) Pseudomembranous colitis: CT evaluation. J Comput Assist Tomogr 11:1017–1020PubMedCrossRefGoogle Scholar
  52. Merine DS, Fishman EK, Jones B, Nussbaum AR, Simmons T (1987b) Right lower quadrant pain in the immunocompromised patient: CT findings in 10 cases. AJR Am J Roentgenol 149:1177–1179PubMedGoogle Scholar
  53. Moir CR, Scudamore CH, Benny WB (1986) Typhlitis: selective surgical management. Am J Surg 151:563–566PubMedCrossRefGoogle Scholar
  54. Morris JB, Zollinger RM Jr, Stellato TA (1990) Role of surgery in antibiotic-induced pseudomembranous enterocolitis. Am J Surg 160:535–539PubMedCrossRefGoogle Scholar
  55. Otaibi AA, Barker C, Anderson R, Sigalet DL (2002) Neutropenic enterocolitis (typhlitis) after pediatric bone marrow transplant. J Pediatr Surg 37:770–772PubMedCrossRefGoogle Scholar
  56. Otchy DP, Nelson H (1993) Radiation injuries of the colon and rectum. Surg Clin North Am 73:1017–1035PubMedGoogle Scholar
  57. Papa A, Scaldaferri F, Danese S, Guglielmo S, Roberto I, Bonizzi M, Mocci G, Felice C, Ricci C, Andrisani G, Fedeli G, Gasbarrini G, Gasbarrini A (2008) Vascular involvement in inflammatory bowel disease: pathogenesis and clinical aspects. Dig Dis 26:149–155PubMedCrossRefGoogle Scholar
  58. Philpotts LE, Heiken JP, Westcott MA, Gore RM (1994) Colitis: use of CT findings in differential diagnosis. Radiology 190:445–449PubMedGoogle Scholar
  59. Ribeiro MB, Greenstein AJ, Yamazaki Y, Aufses AH Jr (1991) Intra-abdominal abscess in regional enteritis. Ann Surg 213:32–36PubMedCrossRefGoogle Scholar
  60. Ros PR, Buetow PC, Pantograg-Brown L, Forsmark CE, Sobin LH (1996) Pseudomembranous colitis. Radiology 198:1–9PubMedGoogle Scholar
  61. Schindera ST, Nelson RC, DeLong DM, Jaffe TA, Merkle EM, Paulson EK, Thomas J (2007) Multi-detector row CT of the small bowel: peak enhancement temporal window—initial experience. Radiology 243:438–444PubMedCrossRefGoogle Scholar
  62. Schlatter M, Snyder K, Freyer D (2002) Successful nonoperative management of typhlitis in pediatric oncology patients. J Pediatr Surg 37:1151–1155PubMedCrossRefGoogle Scholar
  63. Shamberger RC, Weinstein HJ, Delorey MJ, Levey RH (1986) The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. Cancer 57:603–609PubMedCrossRefGoogle Scholar
  64. Soyer P, Martin-Grivaud S, Boudiaf M, Malzy P, Duchat F, Hamzi L, Pocard M, Vahedi K, Rymer R (2008) Linear or bubbly: a pictorial review of CT features of intestinal pneumatosis in adults. J Radiol 89:1907–1920PubMedCrossRefGoogle Scholar
  65. Talbot RW, Heppell J, Dozois RR, Beart RW Jr (1986) Vascular complications of inflammatory bowel disease. Mayo Clin Proc 61:140–145PubMedGoogle Scholar
  66. Thoeni RF, Cello JP (2006) CT imaging of colitis. Radiology 240:623–638PubMedCrossRefGoogle Scholar
  67. Wagner ML, Rosenberg HS, Fernbach DJ, Singleton EB (1970) Typhlitis: a complication of leukemia in childhood. AJR Am J Roentgenol 109:341–350Google Scholar
  68. Wall SD, Jones B (1992) Gastrointestinal tract in the immunocompromised host: opportunistic infections and other complications. Radiology 185:327–335PubMedGoogle Scholar
  69. Wood BJ, Kumar PN, Cooper C, Silverman PM, Zeman RK (1995) Pneumatosis intestinalis in adults with AIDS: clinical significance and imaging findings. AJR Am J Roentgenol 165:1387–1390PubMedGoogle Scholar
  70. Yamamoto K, Kiyohara T, Murayama Y et al (2005) Production of adiponectin, an anti-inflammatory protein, in mesenteric adipose tissue in Crohn’s disease. Gut 54:789–796PubMedCrossRefGoogle Scholar
  71. Yilmaz T, Sever A, Gur S, Killi RM, Elmas N (2002) CT findings of abdominal tuberculosis in 12 patients. Comput Med Imaging Graph 26:321–325PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Philippe Soyer
    • 1
  • Mourad Boudiaf
    • 1
  • Youcef Guerrache
    • 1
  • Christine Hoeffel
    • 2
  • Xavier Dray
    • 3
  • Patrice Taourel
    • 4
  1. 1.Department of Abdominal ImagingHôpital Lariboisière-AP-HP, Université Diderot-Paris 7Paris Cedex 10France
  2. 2.Department of RadiologyHôpital Robert DebréReims CedexFrance
  3. 3.Department of Digestive DiseasesHôpital Lariboisière-AP-HP, Université Diderot-Paris 7Paris Cedex 10France
  4. 4.Department of Medical ImagingHôpital LapeyronieMontpellier Cedex 5France

Personalised recommendations