Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. ESGE/ESGAR do not recommend barium enema in this setting (strong recommendation, high quality evidence). 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence). 3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence). 4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp  ≥  6  mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence). 5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence).

Small bowel obstruction due to a persistent omphalomesenteric duct.

We report a case of a Meckel diverticulum connected with the umbilicus through a fibrotic cord causing small bowel obstruction. On admission, the patient presented with an acute abdomen. A plain upright radiography of the abdomen, an ultrasonography of the abdomen, and an enema with gastrografin were performed, showing a small bowel obstruction at the level of the pre-terminal ileum, without revealing the cause. Urgent surgery followed, showing a persistent omphalomesenteric duct connected to the abdominal wall through a fibrotic cord, with a secondary volvulus of the small bowel. The remnant was resected and the volvulus reduced. The post-operative course was uneventful. Because of the serious complications and even possible mortality due to ischemic disease of the affected small bowel the possibility of a complicated persistent omphalomesenteric duct should be kept in mind, even if the preoperative work-up does not reveal a Meckel diverticulum.