CT hypoperfusion complex
Updates to Article Attributes
Shock bowel (or CT hypoperfusion complex) refers to a radiographic feature whichabdominal imaging features that occurs in the context of profound hypotension16
Pathology
Aetiology
Shock bowel is most commonly described in the context of post-traumatic hypovolaemic shock but can also occur in sepsis, cardiac arrest and diabetic ketoacidosis 1-2.
Radiographic features
CT
Features of CT hypoperfusion complex have been defined as (some or all of these features may be present):
- thickened bowel loops (>3 mm) with enhancing walls (if IV contrast has been administered) or hyperdense walls compared to the psoas muscle 2, 6
- collapsed inferior vena cava: AP diameter <9 mm in three consecutive segments; i.e. 20 mm both above and below the renal veins and the perihepatic portion 2, 6
- halo sign: low density (<20 HU) fluid surrounding the IVC 6
- small calibre abdominal aorta: AP diameter <13 mm both 20 mm above and below the renal arteries 2
- shock pancreas: heterogeneous enhancement with peripancreatic fluid (<20 HU) 2, 6
- hypoenhancment of the spleen (subjective) 2
- hypoenhancement of the liver: 25 HU less than the spleen 6
- bilateral adrenal gland hyperenhancement may be a feature 7
Prognosis
CT findings tend to be reversible with appropriate fluid management 3 although severe hypotension and shock have a significant mortality rate.
Differential diagnosis
The clinical context is extremely valuable for image interpretation. The differential for thickened enhancing bowel includes 4-5:
- idiopathic angioedema
- hereditary angioedema
- ischaemic bowel
- vasculitides (e.g. Henoch-Schonlein purpura)
- infection
- inflammatory bowel disease
- radiation enteritis
- submucosal or intramural haemorrhage (e.g. coagulopathy)
-<p><strong>Shock bowel</strong> (or <strong>CT hypoperfusion complex</strong>) refers to a radiographic feature which occurs in the context of profound hypotension <sup>1</sup>. The <a href="/articles/small-bowel">small bowel</a> is more commonly affected than the <a href="/articles/large-intestine-1">large bowel</a> <sup>6</sup>. </p><h4>Pathology</h4><h5>Aetiology</h5><p>Shock bowel is most commonly described in the context of post-traumatic hypovolaemic shock but can also occur in sepsis, cardiac arrest and diabetic ketoacidosis <sup>1-2</sup>. </p><h4>Radiographic features</h4><h5>CT</h5><p>Features of CT hypoperfusion complex have been defined as (some or all of these features may be present):</p><ul>- +<p><strong>Shock bowel</strong> (or <strong>CT hypoperfusion complex</strong>) refers to abdominal imaging features that occurs in the context of profound hypotension. The <a href="/articles/small-bowel">small bowel</a> is more commonly affected than the <a href="/articles/large-intestine-1">large bowel</a>. </p><h4>Pathology</h4><h5>Aetiology</h5><p>Shock bowel is most commonly described in the context of post-traumatic hypovolaemic shock but can also occur in sepsis, cardiac arrest and diabetic ketoacidosis <sup>1-2</sup>. </p><h4>Radiographic features</h4><h5>CT</h5><p>Features of CT hypoperfusion complex have been defined as (some or all of these features may be present):</p><ul>