Colonic wall thickening in cirrhotic patients: CT features and its clinical significance

Background: To evaluate the computed tomographic (CT) features of colonic wall thickening in cirrhotic patients and to determine their prognostic value. Methods: We retrospectively reviewed 28 cirrhotic patients with colonic wall thickening (110 mm) on CT. Twenty-six of the 28 patients had hepatocellular carcinoma. The severity of hepatic dysfunction was determined by using the Child-Pugh classification. We analyzed the patterns of bowel wall thickening and degree of portal hypertension on CT and the survival periods after initial CT detection of colonic wall thickening. Results: The involved segment of the colon was diffusely thickened with either scalloped or nodular circumferential configuration. In all patients, the thickened colonic wall enhanced poorly. Although the ascending colon was involved in all patients, the transverse (n = 14) or descending (n = 5) colon was also simultaneously involved. Most patients exhibited an advanced stage of portal hypertension on CT. The median survival period of 25 patients who expired was 34 days, and 21 patients (84%) expired within 3 months. Conclusions: Colonic wall thickening on CT can be used as one of the indicators of poor prognosis in cirrhotic patients. Advanced liver cirrhosis with significantly severe dysfunction is the likely cause of mortality. Therefore, a less aggressive therapeutic approach is recommended if hepatocellular carcinoma is coexistent in these patients.