الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute colorectal disorder encompasses a wide range of abnormalities that are often seen in emergency rooms, and radiology plays a critical part in their diagnosis and treatment. For delivering effective patient care, understanding the imaging characteristics of these entities, as well as the range of related complications, is crucial. In the acute diseases, MDCT is the preferred imaging modality, and the radiologist must be familiar with the imaging findings of a wide range of colorectal emergencies and related complications.
MDCT considered the most widely available, easily accessible and comprehensive imaging technique in the setting of emergency and considered the key imaging modality used in the workup of colorectal patients presented with acute presentation.
This study was carried out on 48 patients clinically presenting with acute colorectal manifestation referred to the Radiology Department of Alexandria University Hospitals for dedicated MDCT abdomen evaluation. All patients were subjected to full history taking, clinical examination and laboratory investigation were done.
Fasting would not always be attainable in an emergency setting. Non contrast scanning was performed for all patients. Non-ionic iodinated contrast material was administered to 33 patients with normal creatinine clearance except two patients with low creatinine clearance were on dialysis. IV contrast was not injected in 15 patients due to risk versus benefit ratio as some patients with low creatinine clearance result and were not on dialysis while others, NCCT was informative enough for management in emergency setting. CT enterocolonography was done for one patient with suspected GIT bleeding. CT colonography was used for eight patients, one of them was given positive contrast, the rest were given neutral contrast (water).
The acquisition protocol was tailored according to the patient’s presentation and suspected diagnosis. Post contrast images were acquired as follows: Arterial phase starting 30 seconds after the contrast administration, the portal venous phase started 70 seconds after the starting point from contrast administration, finally delayed scans starting 3 minutes from the starting point.
The current study included 48 patients; 25 males and 23 females. Their ages ranged between 17 years and 78 years. The final result confirmed by surgical findings in four patients, pathological findings in 28 patients, clinical response to medical treatment in 12 patients, interventional drainage in two patients and angiography in two patients.
Accurate MDCT diagnosis was made in 46 patients. The final confirmed diagnosis was acute inflammatory colorectal lesions in 31 patients, neoplastic colorectal lesions in seven patients, angiodysplasia in two patients and others in eight patients.
Among the 31 patients diagnosed as acute inflammatory colorectal lesions, 16 patients had acute appendicitis (10 were uncomplicated and six were complicated), eight patients had acute diverticulitis (two were uncomplicated and six were complicated), three patients had stercoral colitis (two of them with LBO), two had typhlitis (one was uncomplicated and the second was complicated with abscess formation), one had PMC, and one had Crohn’s colitis.
The six patients of complicated acute appendicitis included one with phlegmon and abscess, two with abscess, two with perforation and abscess and one with perforation.
The six patients of complicated diverticulitis included one with pericolic extraluminal rim enhancing gas, one with abscess, one with abscess and LBO, one with abscess and perforation, one with perforation and one with perforation and LBO.
Among the seven patients who diagnosed as neoplastic colorectal lesions, four patients were complicated with LBO, one patient had LBO with abscess, one patient had intussusception with LBO and one patient had abscess.
Among the eight patients who presented with others, two patients presented with hernia with LBO, three patients presented with volvulus, one patient presented with extracolonic renal mass with LBO, one patient presented with iatrogenic sigmoid perforation, and one patient presented with foreign body trauma.
The three patients of volvulus associated with LBO in addition to one of them showed sigmoid ischaemia and one showed sigmoid perforation.
This study confirmed that MDCT was a dependable investigatory method for the differential diagnosis of acute presentation of colorectal lesions subsequently limiting patients’ morbidity and mortality rates and leading to prompt management.