Lupus Ischemic Bowel Disease Presenting as Acute Abdominal Pain——Diagnostic Value of Spiral CT_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SONG Bin ¹ , XU Juan ² , LUO Xiaohua ¹ , WU Bi ¹ , CHENG Yan ¹ , ZHANG Jin. ³

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Systemic lupus erythematosus; Ischemic bowel disease; Acute abdomen; Computed tomography

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ObjectiveTo evaluate the value of spiral CT in diagnosing ischemic bowel changes in systemic lupus erythematosus (SLE) patients presenting with acute abdominal pain. MethodsThe clinical data and spiral CT imaging files of 23 SLE patients presenting with acute abdominal pain were retrospectively reviewed. Sixteen had contrastenhanced spiral CT scanning of the abdomen, the rest had plain CT study. Observation emphasis was placed on the changes of bowel wall (wall thickness, enhancement pattern, lumen size) and mesentery (mesenteric edema, engorgement of mesenteric vessels and their abnormal arrangement pattern). Other abnormal findings (e.g. fluid accumulation, changes of abdominal solid organs, lymphadenopathy) were also observed. ResultsNineteen patients had intestinal wall thickening (19/23, 82.6%), with the “target sign” in 12 patients (12/16, 75.0%); Bowel lumen dilatation was present in 16 patients (16/23, 69.6%). Mesenteric swelling with increased density of adipose tissue was noticed in 21 patients (21/23, 91.3%); 18 patients had engorgement of mesenteric vessels (18/23, 78.3%), with comb like arrangement in 4 patients (4/16, 25.0%). Other abnormal findings included ascites, hydrothorax, hydropericardium, hepatosplenomegaly and so on. ConclusionThe most common CT findings in SLE patients presenting with acute abdominal pain are the signs associated with ischemic bowel disease. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.

Citation： SONG Bin,XU Juan,LUO Xiaohua,WU Bi,CHENG Yan,ZHANG Jin.. Lupus Ischemic Bowel Disease Presenting as Acute Abdominal Pain——Diagnostic Value of Spiral CT. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2004, 11(4): 359-363. doi: Copy

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1. Steinberg AD. Systemic lupus erythematosus [M]. In： Wyngaarden JB, Smith LH, eds. Cecil textbook of medicine. 18th ed. Philadelphia, PA： Saunders, 1988∶2014-2018.
2. 张烜，曾学军，董怡. 以胃肠道为首发表现的SLE二例误诊分析 [Ｊ]. 北京医学， 2000； 22（1）∶54.
3. 李小刚，李德如. 以腹水为主要临床表现的SLE 1例 [Ｊ]. 重庆医学， 2000； 29（2）∶封三.
4. 邢广群，赵晨霄. 狼疮性血管炎的临床表现与发病机理 [Ｊ]. 中华肾脏病杂志， 1999； 15（4）∶25.
5. Kistin MG, Kaplan MM, Harrington JT. Diffuse ischemic colitis associated with systemic lupus erythematosus——response to subtotal colectomy [Ｊ]. Gastroenterology， 1978; 75(6)∶1147.
6. Hoffman BI, Katz WA. The gastrointestinal manifestations of systemic lupus erythematosus: a review of the literature [Ｊ]. Semin Arthritis Rheum, 1980; 9(4)∶237.
7. Laing TJ. Gastrointestinal vasculitis and pneumatosis intestinalis due to systemic lupus erythematosus: successful treatment with pulse intravenous cyclophosphamide [Ｊ]. Am J Med, 1988; 85(4)∶555.
8. Taourel PG, Deneuville M, Pradel JA, et al. Acute mesenteric ischemia: diagnosis with contrastenhanced CT [Ｊ]. Radiology, 1996; 199(3)∶632.
9. Heiberg E, Wolverson MK, Sundaram M, et al. Body computed tomography findings in systemic lupus erythematosus [Ｊ]. J Comput Tomogr, 1988; 12(1)∶68.
10. Ko SF, Lee TY, Cheng TT, et al. CT findings at lupus mesenteric vasculitis [Ｊ]. Acta Radiol, 1997; 38(1)∶115.
11. Reissman P, Weiss EG, Teoh TA, et al. Gangrenous ischemic colitis of the rectum: a rare complication of systemic lupus erythematosus [Ｊ]. Am J Gastroenterol, 1994; 89(12)∶2234.
12. Shapeero LG, Myers A, Oberkircher PE, et al. Acute reversible lupus vasculitis of the gastrointestinal tract [Ｊ]. Radiology, 1974; 112(3)∶569.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Lupus Ischemic Bowel Disease Presenting as Acute Abdominal Pain——Diagnostic Value of Spiral CT

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