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Thickened Gastrointestinal Wall Findings on Computed Tomography in Children: A Reason for Endoscopy?

Min, Steve B.*; Nylund, Cade M.; Abbas, Mazen I.*; Carter, Milissa*; Olsen, Cara H.; Biko, David M.; Goldman, Matheu D.*

Journal of Pediatric Gastroenterology & Nutrition: September 2013 - Volume 57 - Issue 3 - p 305–310
doi: 10.1097/MPG.0b013e3182952eaa
Original Articles: Gastroenterology

Objectives: Bowel wall thickening on computed tomography (CT) scans in children may raise concern for inflammatory bowel disease (IBD). The significance of this radiological finding is unclear. Our purpose was to evaluate the clinical outcomes with regard to IBD in children with no known underlying disease, presenting with abdominal pain and thickened bowel wall on CT scan.

Methods: A retrospective analysis of pediatric patients with abdominal pain and CT findings of thickened bowel wall was performed between 2006 and 2010. Endoscopic findings, clinical variables, and follow-up assessments were evaluated.

Results: Fifty-six patients presenting with abdominal pain and thickened bowel wall findings on CT scan were identified. Overall, 30 (54%) had terminal ileum wall thickening, 17 (30%) had isolated colonic wall thickening, and 9 (16%) had other small bowel wall thickening. Of the 56 patients, 21 (38%) underwent endoscopy, of which 14 (67%) had positive findings—11 (79%) had histologic evidence of chronic colitis, and 5 (36%) had duodenitis/ileitis. Ultimately, 11/56 (20%) were diagnosed as having IBD, 8/56 (14%) with functional abdominal pain/constipation, 9/56 (16%) appendicitis, 10/56 (18%) infectious gastroenteritis, and 18/56 (32%) with miscellaneous diagnoses. Median levels of erythrocyte sedimentation rate, C-reactive protein, albumin, and platelet count were significantly abnormal in the IBD group compared to the non-IBD group. Additional follow-up of those who did not undergo endoscopic evaluation revealed no new diagnoses of IBD.

Conclusions: The presence of thickened bowel wall on CT scans is a nonspecific finding in children. Laboratory evaluation may help distinguish which patients require additional evaluation and endoscopy.

*Department of Pediatrics, Walter Reed National Military Medical Center

Department of Pediatrics, Uniformed Services University of the Health Sciences

Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD.

Address correspondence and reprint requests to Steve B. Min, Department of Pediatrics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889 (e-mail: Steven.min@gmail.com).

Received 29 November, 2012

Accepted 28 March, 2013

The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Army, the US Air Force, Department of Defense, or the US government.

The author reports no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,