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Forum Name: Colon and Rectal Cancers

Question: Segmental wall thickening in the colon


 chrisward - Thu Jun 10, 2010 10:11 pm

I'm a 41 year old white mail who was recently hospitalized for micro perforation by diverticulitis. The CT scan showed that, apart from the perforation, there was "segmental wall thickening on the hepatic flexure". The comments read: "Neoplastic process is suspected". What might that mean? Cancer? Benign polyps? How concerned should I be as I wait for a colonoscopy?
 Dr.M.Aroon kamath - Fri Jun 18, 2010 12:27 pm

User avatar Hi,
Bowel wall thickening (as reported on CT scans of the abdomen with contrast enhancement) refers to "mural stratification", which to a radiologist means the abnormal separation of the contrast-enhancing outer gut layers (serosa/muscularis propria) from the contrast-enhancing inner gut layers (mucosa/muscularis mucosa).

Bowel wall thickening can be
- focal (a few centimeters),
- segmental (10-30 cm), or
- diffuse (involving most of the small bowel or large bowel).

Focal thickening: Majority of neoplasms of the GI (gastrointestinal) tract commonly show up as a focal areas of bowel wall thickening. Inflammatory conditions such as appendicitis, diverticulitis, and rarely tuberculosis may present with this picture.

Segmental thickening: usually seen in inflammatory pathologies such as Crohn's disease, intestinal ischemia, infectious enteritis, & radiation enteritis. Other considerations that may show this pattern are lymphoma & intramural hemorrhage.

Diffuse thickening: is seen with a number of inflammatory pathologies, such as ulcerative colitis, infectious enteritis, and some non-inflammatory states such as edema associated with protein deficiency states, cirrhotic portal hypertension and low-flow ischemia.

In your case, as you seem to have had micro-perforations secondary to diverticulitis, it is probable that the segmental wall thickening that was reported could have been due to the inflammatory process in the general peritoneal cavity. However, it is mandatory that you should have yourself fully investigated (including colonoscopy/biopsy).
Best wishes!

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