Imaging description

Colonic wall thickening (often defined as a colonic wall thickness greater than 6 mm, although most radiologists use expert judgment to make this diagnosis in practice) is a common finding in patients with cirrhosis and portal hypertension, and appears to reflect the congestive effect of elevated portal venous pressure (Figures 64.1 and 64.2) [1, 2]. While any or all of the large bowel may be affected, the right colon is frequently the only or dominant site of involvement [1]. It has been postulated that such preferential involvement of the right colon reflects drainage of the left colon through the inferior mesenteric vein to the splenic vein, with relative decompression through short gastric, lienorenal, or gastroesophageal venous collaterals [1]. The condition is variable and, for example, can occur in non-cirrhotic portal hypertension or affect the left colon disproportionately (Figure 64.3).

Importance

Colonic wall thickening in cirrhosis should not be mistaken for colitis or colon cancer, since this may provoke unnecessary investigation and patient anxiety. Portal hypertensive colonic wall thickening is correlated with the degree of cirrhosis and portal hypertension [3].

Typical clinical scenario

The reported frequency of colonic wall thickening in cirrhotic patients varies between 33% (21 of 63) and 37% (21 of 57) [1, 2]. As such, it is common to see colonic wall thickening as an incidental finding in cirrhotic patients.