ENDOSCOPIC FINDINGS IN PATIENTS WITH BOWEL WALL THICKENING ON EMERGENCY ROOM CT SCANS

Aims:

Patients presenting to the Emergency Room with abdominal pain, fever or blood in stools often undergo an urgent CT scan, often revealing bowel wall thickening (BWT). The aim of the current study is to evaluate the significance of such BWT and assess predictors of significant pathology.

Methods:

Patients referred to gastroenterology service from the emergency department at Hamad Medical Corporation, Qatar between July 2015-July 2017 with BWT were retrospectively analyzed. Apart from the CT features, the correlation of endoscopic findings to the clinical presentation, inflammatory markers and histopathology were studied. Patients with known GI pathology, evidence of luminal obstruction, strictures and luminal mass on CT were excluded.

Results:

109 of 160 patients referred were enrolled in the data analysis. Endoscopic appearance was normal in 37/109 (33.9%) of patients. 41/109 patients (37.6%) had significant chronic pathology – 21 IBD (19.1%) of which 13 CD (11.9%), 8 UC (7.3%), 9 TB (8.3), 11 Malignancy (10.1%). 31/109 (28.4%) had mucosal abnormalities but normal or acute inflammation on histopathology.

Symptoms of diarrhea or pain > 2 weeks were the strongest predictor of significant findings on endoscopy. Other features such as blood in stool, fever and weight loss were also associated with having significant pathology.

Laboratory parameters such as mean WBC, Hb, ESR, Albumin and CRP do not differ significantly. Mean Calprotectin was significantly higher in patients with IBD and TB (199.5 ± 299.8 vs. 809.8 ± 540.8; P < 0.001).

Conclusions:

One Third of the patients in the study had significant pathology (IBD/TB/Malignancy). Patients with upper GI BWT have low likelihood of significant pathology compared to lower GI BWT. Until further prospective data becomes available, endoscopic assessment may be warranted in most patients with bowel wall thickening on CT scans.