bowel pathology

  • ultrasound cannot exclude bowel pathology.

normal bowel

  • thin hypoechoic mucle wall <3mm
  • hyperechoic central mucosa that does not breech through the external hypoechoic muscle
  • undulating contour but fairly uniform wall thickness.
  • freely peristalsing
  • minimal/no discernable vascularity with colour doppler.
  • large bowel and small bowel understandably have different appearances.

normal stomach

ultrasound of the stomach that is distended with solid contents (as opposed to fluid). axial plane – longitudinal stomach.

ultrasound of a stomach distended with solid contents. assessment in 2 planes and scanning from side to side is important to not mistake this for a mass.

hiatus hernia

ultrasound image- hiatus hernia seen superior and deep to left lobe of the liver.

the red arrow indicates the gastro-oesophageal junction.

best viewed in an oblique-sagittal plane.

inflamatory bowel disease

transverse view of the tender region.

  • the bowel wall is inconsistant in it’s thickness.
  • the wall is not uniformly hypoechoic.
  • colour doppler shows marked hyperaemia of both wall an mucosa.
  • tiny spiculations are visible around the bowel consistant with reactive oedema.

longitudinal view of the bowel.

  • power doppler shows marked hyperaemia of the thickened mucosa.
  • the bowel wall is thickened and irregular.
  • the wall has central echogenic change consistant with inflammation.

crohn's disease

ultrasound image- thickened bowel wall.

ultrasound image- transverse view showing the large “target ” sign. there are thickened hypoechoic walls.

diverticular disease / diverticulitis

ultrasound image- this shows inflamed diverticulae coming from the bowel wall.

ultrasound image- ascending colon diverticulitis.
it is adjacent to the gallbladder.

acute diverticulitis with localised perforation

the patient was experiencing right upper to lower abdominal pain.

ultrasound image- irregular , heterogeneous mass in the right mid abdominal quadrant. at the lateral wall of the colon in the region of inflammation there are 2 echogenic air loculi which appear extraluminal in position. painful on palpation. a ct was performed to confirm the diagnosis. (see below).

ultrasound image- thickened bowel wall which appears to contain gas. there is localised wall thickening with surrounding echogenic inflammatory change of the adjacent mesenteric fat.

same patient. confirmation acute diverticulitis in the ascending colon with localised perforation.

ct shows the perforation with gas/air (arrow)

bowel obstruction

ultrasound image of a stomach markedly distended with mixed contents. this view is transverse through the fundus.

ultrasound image of a stomach markedly distended with mixed contents. the distension extends through to the duodenum

ultrasound image- ascites around bowel loops.

ultrasound image- fluid surrounds the bowel.

gastric band

longitudinal  ultrasound image of gastric band overlying the stomach.

transverse ultrasound image of gastric band port overlying the stomach.

mesenteric adenitis

ultrasound image- hypoechoic lymph node with loss of a normal hyperechoic fatty hilum.

mesenteric cysts

ultrasound image- anechoic circular mass is a mesenteric cyst.

ultrasound image- confirmed with showing no colour flow.

bowel polyp

ultrasound image- this is a transvaginal scan of the left adnexa. there is a hyperechoic nodule within the bowel. it is highlighted due to the water within the bowel.

ultrasound image- the bowel wall is mildly thickened. colonoscopy confirmed the ultrasound findings.

intussuseption

  • whilst intussuseption most commonly occurs in the 2 month to 2 year age group, it may occur at any age.
  • intussusception is the invagination (or telescoping) of one part of bowel into another.
  • most typically it involves the ileum into the caecum however can occur anywhere in the bowel.
  • the risk is ischemia of the ‘trapped’ bowel leading to necrosis and sepsis.
intussusception schematic
schematic of intussusception anatomy. the proximal bowel (intussuseptum) telescopes into the distal bowel (intussuscipiens).
reference article

medscape article on intussuseption.

longitudinal ultrasound image of intussusception at the ileocecal junction in a 69 year old female.

the ileum can be seen within the lumen of the caecum. the surrounding mesenteric adipose tissue is hyperechoic representing oedema. 

images courtesy of callum linehan. 

transverse b-mode and colour doppler image of intussusception at the ileocecal junction.

note the hyperaemia. 

images courtesy of callum linehan. 

ultrasound image proximal to the intussusception demonstrating a fluid distended ileum secondary to the obstruction.  

image courtesy of callum linehan. 

transverse ultrasound image at the intussusception site demonstrating bowel telescoping.

image courtesy of callum linehan. 

carcinoma

longitudinal ultrasound image of the descending colon. this demonstrates the focal wall thickening in stenosing annular colorectal carcinoma and accounts for the ”apple core sign” in barium enema studies. 

image courtesy of callum linehan. 

dual screen ultrasound image of primary adenocarcinoma of the descending colon. this image demonstrates the grossly thickened submucosal lining.

images courtesy of callum linehan. 

colour doppler image of prominent vessels feeding the thickened submucosal lining.

image courtesy of callum linehan. 

colour doppler image of internal vascularity within the submucosa. 

image courtesy of callum linehan. 

a difficult case example of colorectal carcinoma in a large elderly patient with generalised abdomen pain. 

the ultrasound image is longitudinal to the ascending colon and demonstrates a thickened segment due to primary adenocarcinoma.

images courtesy of callum linehan. 

colour doppler image longitudinal to the ascending colon demonstrating increased wall vascularity at the site of malignancy.  

image courtesy of callum linehan. 

transverse dual screen ultrasound image comparing the malignant segment of the ascending colon (left) with a normal segment (right).

note the the annular wall thickening.

image courtesy of callum linehan. 

transverse ultrasound image of the ascending colon highlighting the anatomy of the malignant segment.  

images courtesy of callum linehan. 

ultrasound image of a large splenic hilar mass.

this case presented with liver metastasis and altered bowel habits. 

image courtesy of callum linehan. 

ultrasound image – closer interrogation of the relational anatomy shows the mass involving the colon wall at the splenic flexure. biopsy concluded adenocarcinoma. 

image courtesy of callum linehan. 

ultrasound image of the terminal ileum. a small neuroendocrine carcinoma presents as a hypoechoic endoluminal mass.

image courtesy of callum linehan. 

colour doppler image – demonstrates the feeding vessels of the endoluminal mass within the terminal ileum.  

image courtesy of callum linehan. 

ultrasound image of regional lymphadenopathy adjacent to the terminal ileum – suggesting a metastatic process. 

image courtesy of callum linehan. 

ultrasound image of an enlarged atypical regional mesenteric lymph node – metastatic neuroendocrine carcinoma. 

image courtesy of callum linehan.