Computed tomography of the small bowel

With exquisite spatial and contrast resolution, state of the art CT equipment provides a unique cross-sectional perspective to the small bowel and mesentery. The strength of CT lies in its ability to directly image the extramucosal (mural, serosal, mesenteric) components of diseases affecting the small bowel. In our hospitals, CT currently plays a dominant role in evaluating patients with complicated Crohn's disease and disseminated intraabdominal malignancy, frequently replacing the barium small bowel examination. CT also serves an important problem solving function in assessing questionable mesenteric mass effects discovered on barium studies. More difficult to assess is the clinical impact and cost-effectiveness of CT in evaluating patients with acute abdominal pain or obstructive symptoms. CT is superior to plain films in detecting pneumatosis intestinalis, acute intramural hematoma, bowel wall thickening, abscess, intussusception, and closed loop obstruction. Further study of this issue is needed, but we predict continued growth in the use of computed tomography as a screening procedure for suspected small bowel disease.