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Acute gastrointestinal vaso-occlusive ischemia in sickle cell disease: CT imaging features and clinical outcome.

Publication ,  Journal Article
Gardner, CS; Jaffe, TA
Published in: Abdom Radiol (NY)
March 2016

PURPOSE: The purpose of this study was to determine the incidence, specific imaging features, and outcome of gastrointestinal vaso-occlusive ischemia (GVOI) in sickle cell patients undergoing CT for acute abdominal pain. METHODS: This HIPAA-compliant, IRB-approved retrospective study evaluated sickle cell patients with an abdominal pain crisis and acute gastrointestinal abnormalities on CT from 1/2006 to 1/2014. CT findings were divided into those compatible and incompatible with bowel ischemia or clinical diagnosis of GVOI. Two abdominal radiologists (1, 13 years' experience) reviewed the CTs for specific imaging features of ischemia. Clinical laboratory values (lactate, WBC) and outcome were recorded. Descriptive statistics and Wilcoxon-Mann-Whitney two-sample rank-sum test were performed. RESULTS: Of 217 CTs, 33 had acute gastrointestinal abnormalities: 75% (25/33) consistent with ischemia and clinical GVOI. Complications of ischemia occurred in 16% (4/25): ileus (50%), perforation (25%), and pneumatosis (25%). In uncomplicated cases, all had bowel wall thickening: segmental 52% (11/21) or diffuse 48% (10/21). The colon was commonly involved (76%, 16/21), particularly the ascending (57%, 12/21). Most abnormalities (52%, 11/21) were in the superior mesenteric artery distribution. Average lactate (4.3 ± 4.0 mmol/L, p = 0.02) and WBC count (20.1 ± 10.4, ×1000 cells/μL, p = 0.01) were significantly higher in GVOI. Overall mortality in patients with GVOI was 17% (3/18). CONCLUSION: GVOI is an important feature of the acute abdominal crisis in patients with sickle cell disease and can be seen in up to 75% of patients with abnormal bowel findings on CT. The diagnosis should be strongly considered in sickle cell patients with CT findings of diffuse or segmental bowel wall thickening, particularly involving the colon.

Duke Scholars

Published In

Abdom Radiol (NY)

DOI

EISSN

2366-0058

Publication Date

March 2016

Volume

41

Issue

3

Start / End Page

466 / 475

Location

United States

Related Subject Headings

  • Young Adult
  • Vascular Diseases
  • Tomography, X-Ray Computed
  • Retrospective Studies
  • Radiography, Abdominal
  • Middle Aged
  • Male
  • Ischemia
  • Humans
  • Gastrointestinal Tract
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Gardner, C. S., & Jaffe, T. A. (2016). Acute gastrointestinal vaso-occlusive ischemia in sickle cell disease: CT imaging features and clinical outcome. Abdom Radiol (NY), 41(3), 466–475. https://doi.org/10.1007/s00261-015-0621-7
Gardner, Carly S., and Tracy A. Jaffe. “Acute gastrointestinal vaso-occlusive ischemia in sickle cell disease: CT imaging features and clinical outcome.Abdom Radiol (NY) 41, no. 3 (March 2016): 466–75. https://doi.org/10.1007/s00261-015-0621-7.
Gardner, Carly S., and Tracy A. Jaffe. “Acute gastrointestinal vaso-occlusive ischemia in sickle cell disease: CT imaging features and clinical outcome.Abdom Radiol (NY), vol. 41, no. 3, Mar. 2016, pp. 466–75. Pubmed, doi:10.1007/s00261-015-0621-7.
Journal cover image

Published In

Abdom Radiol (NY)

DOI

EISSN

2366-0058

Publication Date

March 2016

Volume

41

Issue

3

Start / End Page

466 / 475

Location

United States

Related Subject Headings

  • Young Adult
  • Vascular Diseases
  • Tomography, X-Ray Computed
  • Retrospective Studies
  • Radiography, Abdominal
  • Middle Aged
  • Male
  • Ischemia
  • Humans
  • Gastrointestinal Tract