What is the role of imaging studies in the diagnosis of proctitis and anusitis?

Updated: Mar 27, 2020
  • Author: David E Stein, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Generally, no imaging studies are needed if the inflammation is known to be limited to the rectum and the anus. However, if the possibility of inflammatory bowel disease (IBD; that is, either Crohn disease or ulcerative colitis) or ischemia exists, then further imaging studies may be necessary.

If Crohn disease is a possibility, a contrast upper gastrointestinal (GI) radiograph with a small bowel follow-through may reveal terminal ileal disease and jejunal ileal strictures. A baseline computed tomography (CT) scan of the abdomen and pelvis may also show enteroenteric fistulas and bowel wall thickening consistent with Crohn disease.

In infectious colitides, if the patient has been admitted to the hospital, a CT scan may be obtained, which may show colonic and rectal wall inflammation. This may help in determining the diagnosis.

In ischemic proctitis, a CT scan of the abdomen and pelvis with oral and intravenous contrast is obtained. The most common finding is mural thickening confined to the rectum and the sigmoid colon, which is associated with perirectal fat stranding.

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