HomeAnswersMedical Gastroenterologyct abdomenKindly interpret the results of my abdominal CT scan.

What does bowel wall thickening in my CT scan report mean?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At October 1, 2022
Reviewed AtMarch 1, 2023

Patient's Query

Hello doctor,

My CT scan showed some bowel wall thickening, but everything else was fine. I am a little confused by the impression notes.

Kindly help.

Thank you.

Answered by Dr. Ghulam Fareed

Hello,

Welcome to icliniq.com.

I have reviewed your CT scan report (attachment removed to protect the patient's identity). You have left lower abdominal pain and altered bowel habits. Your CT (computed tomography) scan was done without intravenous contrast media. There is a mucosal thickening of the distal sigmoid and rectum without any surrounding lymph node enlargement. This seems to be an inflammatory process secondary to mild infection at your distal gut (sigmoid and rectum), the area in your left lower abdomen, correlating clinically with your symptoms. They recommended going for a sigmoidoscopy or colonoscopy to see internal mucosa. If needed, a small mucosal biopsy can be taken to confirm the etiology. They may have given you some antispasmodics and antibiotics for this. On your CT scan report, they have mistakenly written bronchoscopy; it will be either sigmoidoscopy or complete colonoscopy.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

Yes, the bronchoscopy in the reports confused me also.

Do the report's findings relate to irritable bowel syndrome, diverticulitis, or cancer without any correlated symptoms? I am mainly having intermittent abdominal pain and discomfort.

Thank you.

Answered by Dr. Ghulam Fareed

Hello,

Welcome back to icliniq.com.

1. Irritable bowel syndrome (IBS) is a functional gut disorder; this mucosal thickening is not IBS in your case.

2. Diverticulitis is a possibility, but they must have labeled it because the diverticulum within the gut can be easily appreciated on CT scan.

3. Colon cancer is less likely to be considered as your symptoms, and CT scan findings (absence of surrounding lymph nodes enlargement) are normal.

So your next thought would be, then what is it? This is proctitis or proctosigmoiditis (inflammation of either rectum only or rectum plus some of your sigmoid as well). Simple anti-spasmodic antibiotics for a week should improve your symptoms. You can consult a specialist doctor and take medications with their consent.

For a definitive diagnosis, you have to do a sigmoidoscopy. This area is 30 cm from the anal verge, so sigmoidoscopy is a very simple procedure that can be performed without any sedation.

I hope I was helpful to you.

Thank you.

Patient's Query

Hello doctor,

Thank you for your reply.

I will do some research on proctitis and the other one. I think with my symptoms being limited to pain and inflammation, does it limits a diagnosis? I will also ask the radiologist for a correction and see about further tests.

Answered by Dr. Ghulam Fareed

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I reviewed your past history as well. Your CT (computed tomography) scan abdomen was done six months back and I feel such mild inflammation must have resolved by now.

How are you doing clinically? Please answer these questions.

1) Number of stools in a day?

2) Any change in the consistency of stools?

3) Do you have any abdominal pain or cramps?

4) Do you have a fever or weight loss?

5) What about your sigmoidoscopy or colonoscopy? Whether it was performed or you are still waiting for an appointment date?

I am unable to open your attached images, but I remember your CT scan findings which I already mentioned in my response previously.

Hope this helps.

Thanks and take care.

Patient's Query

Hi doctor,

Thank you for your reply.

I had hoped you would be able to open the images, is there another way I should have sent them? As far as mild inflammation, my pain symptoms still come and go. Where I will have a week with nothing, then another flare after a stressful event, that would last a day then resolve. Currently, have had come-and-go pain for about two weeks now, worse with stress or anxiety.

While reviewing my CT images, I did notice the possible area they noted in the report.

Answers to your questions:

1) The number of stools I have in a day is 1, sometimes 2.

2) Stools are sometimes firm, other times mushy consistency.

3) In my abdomen I have like a dull pain, that does not feel crampy.

4) I do not have a fever or weightloss.

5) I am still awaiting a GI appointment to see if they will schedule a sigmoidoscopy.

Answered by Dr. Ghulam Fareed

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

Now, I reviewed your images (attachment removed to protect the patient's identity). There was mild inflammation but it was not exactly in the area you highlighted. Your on-and-off symptoms that worsen with anxiety and stress, are more related to a sensitive gut like irritable bowel syndrome, rather than proctitis or mild inflammation which was noted in your reports. Inflammation cannot come and go like this, but yes abdominal pain due to gut sensitivity can come and go like this.

I have reviewed your answers, 1 to 2 stools with a mild change in consistency, no fever and no weight loss are reassuring things to be noted.

For your symptoms, I would suggest some anti-spasmodic medications which can help you to relieve abdominal discomfort or pain and you can take them on per need basis, till your gastroenterologist's physical visit.

1. Tablet Mebeverine 135 mg 1 to 2 times per day before meals or as per need during days of abdominal pain.

2. If Mebeverine is not available at your end, you can look for tablet No-spa (Drotaverine). Take either one of them.

However, please consult a physician, discuss with them, and start taking the medications with their consent.

Hope this helps.

Thanks and take care.

Patient's Query

Hi doctor,

Thank you for your reply.

I do not have access to the medicines you recommended, but I have been using turmeric to see if that helps. I think one of my main concerns is the use of the wording in my original report from the radiologist and doing research online. The focal area seems to suggest a worse diagnosis. Since my GI appointment is not now, my assumption is they may schedule me even further for a sigmoidoscopy. I just had 3 to 4 days with no pain or symptoms, but I also attempted an at-home enema, which made me feel really good.

I have now just realized when my stool is more formed, that I occasionally have a groove along an edge, and sometimes it seems flatter, but more the last 3 to 4-inch segment coming out. Is this associated with IBS? I guess I am really confused by the occasional pain, loose stools, and odd-shaped stools. I understand that sigmoidoscopy is probably the only route to go at this point, but in the absence of other concerning symptoms, I am concerned if in the 4 to 5 months since my original CT Scan, could something have gotten worse. I have not had a bad flare-up, but off and on dull pain and my stools seem to be less loose. So I guess that good right? So I guess I am looking for a pattern, but cannot find a definite one.

Answered by Dr. Ghulam Fareed

Hi,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I have reviewed your old case history and I will answer you one by one,

1) Turmeric is fine if you feel you are getting better with it, otherwise, no direct relationship between this and your initial CT scan findings.

2) You are right, it will be more worrisome if this focal area was on the right-sided colon or mid-colon, distal-most colon, such findings are relatively common and without surrounding lymph nodes, this more likely seems to be inflammatory.

3) I think they will schedule you a bit early for a sigmoidoscopy, they have already waited for a couple of months now. Which sort of enemas are you using?

4) I did not understand this statement that a 3 to 4-inch segment is coming out. Is it coming out from the anal verge and for how long? You have not mentioned this before.

5) If you are thinking and worried about this continuously for a couple of months, I think you will not be able to have a stable pattern of stools because stool consistency and frequency can easily be changed with your overall thinking or stress levels.

6) Well, considering proctitis, it should be improved or persistent, chances of worsening are relatively less, considering no lymph nodes on the initial CT scan.

7) There is one blood test that we do for suspected lesions, known as CEA (carcinoembryonic antigen) levels, you can do that, till your appointment, if possible.

Hope this levels.

Thanks and take care.

Patient's Query

Hello,

Thank you for your reply.

For an enema, I really just did a warm saline solution. I forgot to mention, it seemed I saw more of the oral contrast I ingested from my CT scan was flushed out. Sorry, I was trying to describe my stool with an indent along one side that did not appear to be the entire length. I have only noticed this more recently but did not think about it until the last couple of weeks. I will look into the CEA test. Is there a time frame that CT scan findings are less reliable? Would a GI doctor find reviewing 5-month-old scans unnecessary?

Answered by Dr. Ghulam Fareed

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I think if your stool consistency and frequency are relatively normal, so no need for warm saline enemas, except if you feel better with this.

No there is no specific time frame, it varies from case to case, whether there is a need to repeat the CT scan or not. In your case, they will go for a sigmoidoscopy directly first. If everything is fine no need for a repeat CT scan, if they will find anything unusual, maybe they will ask for repeat imaging. I guess, there is absolutely no point in worrying about the upcoming sigmoidoscopy results because there is no way we can predict anything before actually doing that.

Hope this helps.

Thanks and take care.

Patient's Query

Hello doctor,

Thank you for your reply.

I tend to worry more when I feel a dull ache. Then of course I do not think about it much when there is none.

Last thought I wondered about based on the report I shared previously. It states focal wall thickening in the distal sigmoid and rectum. Focal is a small area in my understanding, so is this mentioning finding multiple areas from the rectum to sigmoid or general inflammation? I would not really know until a GI looks at the images. I just was really interested in what exact areas they were noted on the report.

Answered by Dr. Ghulam Fareed

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I have reviewed your CT scan report again (attachment removed to protect the patient's identity), they have written as sigmoid and rectum wall thickening and then they wrote this may represent focal inflammation, that focus word means limited to sigmoid and rectum, because there are certain diseases of the colon which actually causes diffuse inflammation of whole colon like ulcerative colitis. So this focal is not a particular isolated small area, if that is the case, radiologists always mention size, like 8 mm thickening within the rectum involving around 5 cm segment.

Hope this helps.

Thanks and take care.

Patient's Query

Hello doctor,

Thank you for your reply.

So are you saying he may have worded the report wrong similar to how he wrote bronchoscopy and should have written sigmoid or colonoscopy? Trying to deduce what he wrote has probably caused more frustration in my case. So he is really stating mild inflammation of the rectum and sigmoid (colitis), nonspecific, otherwise he would have noted specific findings. I considered weeks ago sending the images to another radiologist for a second opinion mainly because of his wording error.

Answered by Dr. Ghulam Fareed

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

The mention of bronchostomy was a definite mistake, but rectosigmoid wordings were not that bad.

Hope this helps.

Thanks and take care.

Patient's Query

Hello doctor,

Thank you for your reply.

It had me more concerned that the wording was implying the findings of a lesion or tumor of some sort based on my research on the use of “focal” in radiology reports. But I do understand CT scans are not the best diagnostics for the abdomen. You have been a tremendous help. I will let this one rest for now until I see a GI next month. Thanks again.

Answered by Dr. Ghulam Fareed

Hello,

Best regards,

Thank you and take care.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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