Evaluation of Submucosal Lesions of the Large Intestine

Department of Radiology, University of Wisconsin Medical School, 600 Highland Ave, E3/311 Clinical Science Center, Madison, WI 53792-3252, USA.
Radiographics (Impact Factor: 2.6). 11/2007; 27(6):1693-703. DOI: 10.1148/rg.276075028
Source: PubMed

ABSTRACT Various nonneoplastic entities may manifest as submucosal abnormalities at colorectal evaluation, and it may be difficult to distinguish between those with an intramural origin and those with an extramural origin on the basis of optical colonoscopy alone. Cross-sectional radiologic imaging, which allows evaluation of the entire bowel wall and the surrounding tissues, plays an important role in the localization and characterization of these abnormalities. However, some superficial submucosal lesions that are initially detected at computed tomographic colonography or barium enema studies may be better characterized with colonoscopy; thus, it is important to recognize the complementary uses of these diagnostic tests. In addition, modalities such as transrectal ultrasonography and magnetic resonance imaging may be useful for the identification and characterization of some abnormalities. For timely and effective management, it is especially important that submucosal neoplasms of the large intestine be accurately distinguished from nonneoplastic entities such as lymphoid polyps, vascular lesions, and cystic lesions, as well as from extracolonic abnormalities (eg, endometriosis, uterine fibroids) and normal extracolonic structures (eg, uterus, vasculature).

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    • "With performing optical colonoscopy, the term "submucosal lesions" may be used to describe any mass-like protrusion into the lumen that spares the overlying mucosa, without regard to an intramural versus extramural origin (1). Therefore, to arrive at a reasonable differential diagnosis of rectal submucosal lesions, disease processes that give rise to both intramural and extramural lesions should be considered (1, 2) (Table 1). "
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    ABSTRACT: Rectal submucosal lesions encompass a wide variety of benign and malignant tumors involving the rectum. With optical colonoscopy, any mass-like protrusion covered by normal mucosa, whether the underlying process is intramural or extramural in origin, may be reported as a submucosal lesion. Whereas the assessment of submucosal lesions may be limited with performing optical colonoscopy, cross-sectional imaging such as CT, transrectal ultrasonography and MRI allows the evaluation of perirectal tissues and pelvic organs in addition to the entire thickness of the rectum, and so this is advantageous for the assessment of rectal submucosal tumors. Among these, MRI is the best investigative modality for soft tissue characterization. Therefore, knowledge of the MRI features of rectal submucosal tumors can help achieve accurate preoperative diagnoses and facilitate the appropriate management.
    Korean journal of radiology: official journal of the Korean Radiological Society 07/2011; 12(4):487-98. DOI:10.3348/kjr.2011.12.4.487 · 1.57 Impact Factor
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    • "If the condition is suspected then the urinary tract should be imaged, as an Urologist may be required [1]. Our case demonstrates that it is rare to be able to be solely reliant on imaging for the diagnosis of intestinal endometriosis [17]. "
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    ABSTRACT: Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common it is rare for the condition to manifest as an acute bowel obstruction secondary to ileocaecal and appendicular endometriosis. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon. We present the case of a 33 year old female of Asian origin who presented with symptoms and signs of an acute small bowel obstruction. A right hemicolectomy for suspected malignancy was performed with an ileocolic anastomosis. Histological examination demonstrated extensive endometriosis of the appendix and ileocaecal junction. Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A high index of suspicion is required to arrive at a diagnosis of this elusive condition.
    World Journal of Emergency Surgery 09/2010; 5(1):27. DOI:10.1186/1749-7922-5-27 · 1.47 Impact Factor
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    ABSTRACT: The case presented involves a thirty-eight year old woman with endometriosis, who was diagnosed by laparoscopic visualization and histopathological confirmation. After one year, and while the patient was on infertility work-up, she referred to a gastroenterologist from the gynecologic clinic because of palpable bulging and nodules discovered in a pelvic exam. Colonic involvement was detected by colonoscopy and endosonography. A pathology report of sections of the colonic mucosa revealed deciduosis (endometriosis). This incidence of this type of endometriosis is quite rare, and involves extensive involvement of colonic mucosa. We recommend careful pelvic examination and rectovaginal palpation in endometriosis pa- tients even if they appear asymptomatic for gastrointestinal complications.
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