Maham Farshidpour, MD, David Kim, MD, Bhaskar Banerjee, MD; Banner University Medical Center, Tucson, AZ
Introduction: CT is commonly used to examine patients who present to with abdominal pain. Moreover, bowel wall thickening (BWT) is a common finding on abdominal CT. Inflammation, malignant processes, or non-significant abnormalities can lead to BWT. BWT on CT is a common reason for gastroenterology consultation and subsequently endoscopic evaluation. The aim of our study was to establish the value of colonoscopy in incidental CT findings of BWT in patients with negative history of gastrointestinal disorders. Methods: This was a retrospective study of involving patients seen between October 2014 and March 2019 at the Banner University Medical Center in Arizona. All patients with BWT on CT who underwent colonoscopy were included. Subjects were excluded if they were under 18 years of age, history of bowel cancer, history of inflammatory bowel disease or chronic liver disease,or if there was a specific CT finding such as a mass. Flexible sigmoidoscopy or colonoscopy with biopsy was performed by gastroenterologists. Results: A total of 117 out of 332 patients (72 females and 45 males) had an abdominopelvic CT with a report of BWT as well as a follow-up colonoscopy. The mean age was 52 years. There were 67 Caucasian patients (57.4%), 41 Hispanic (35%), 4 Native-American (3.4%), 2 Asian (1.7%) and 3 patients (2.5%) were African-American (Table.1). 69 patients (59%) showed significant pathology results. The most common site was the sigmoid in 43 patients (68.2%). We found 3 patients (2.4%) had malignant lesions including 1 (0.8%) patient with adenocarcinoma, 1 (0.8%) carcinoid tumor and 1 (0.8%) with an adenoma with high grade dysplasia. In our study, 48 (41%) of our patients who underwent colonoscopy had normal or no significant pathology findings. We observed that males have a greater proportion of abnormal pathology compared to females (OR 0.31, 95% CI 0.12–0.76; p=0.006). Additionally, rectal bleeding is associated with a greater proportion of abnormal endoscopy (OR 0.19, 95% CI 0.04-0.6; p=0.002). Discussion: With respect to etiology, we found that a significant number of patients with BWT on CT did have underlying pathology on direct visualization. The association is especially strong where there is BWT of the sigmoid colon, male gender and if there is a history of rectal bleeding. Asymptomatic malignancy may be detected; therefore, endoscopic confirmation is practical when a finding of BWT is found on CT examinations particularly with history of gastrointestinal bleeding.
Abbreviation: CI; confidence interval. OR; odd ratio Note: aNormal albumin level range 3.6-5.1 g/Dl; bNormal hemoglobin level range 12-16 g/DL;C P-value < 0.05 indicates northworthy measures. Bold values signify statistically significant p-value.
Disclosures: Maham Farshidpour indicated no relevant financial relationships. David Kim indicated no relevant financial relationships. Bhaskar Banerjee indicated no relevant financial relationships.