SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 1 | 37 Redundancy of colon segments is a reason for incomplete or failed colonoscopy. 26, 54 Figures 1f and g are examples of redundant segments of the colon at CTC. Figure 1h shows redundancy and an acute flexural fold. Examples of colon pathologies seen at CTC are presented in Figures 1i to 1n. Another advantage of a CTC is that a scan covers the entire abdomen from the lung bases to below the pelvis allowing for visualisation of extracolonic organs and structures. 10,28, 54-58 It is not feasible to visualise organs and structures outside of the colon in DCBE and colonoscopy. Figures 2a to 2f are examples of extracolonic findings at CTC. Incomplete colonoscopy: role of radiology imaging Literature underscores that CTC should be performed on patients with incomplete colonoscopy. 9,59-63 The percentage of incomplete colonoscopy studies is reported to range from 0.4% to 15%. 64,65 The 2020 guideline update of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) includes CTC in incomplete colonoscopy and not DCBE as an imaging Figure 1f Grossly redundant transverse colon (TC) with loops lying low in the pelvis Figure 1g Colon-map showing a grossly redundant sigmoid colon (SC), and normal descending colon (DC), transverse colon (TC) and ascending colon (white arrow). R= rectum Figure 1h Colon-map showing an acute flexural fold (white arrow) and redundancy Figure 1i Colon-map of left lateral decubitus with the patient slightly oblique. Red arrow indicates stricture in sigmoid colon due to previous attacks of diverticulitis. R=rectum, TC = transverse colon, AC = ascending colon, and C = caecum. Figure 1k 3D of annular carcinoma in the sigmoid colon Figure 1m 3D showing mass at CTC Figure 1j 2D left lateral decubitus view of patient in Fig 1i. Sigmoid colon (red square). Thickening of colon with multiple diverticula throughout the sigmoid colon (red arrows). Yellow arrow = presence of an intramural sinus tract which indicates a linear collection of fluid within the thickened wall Figure 1l 2D axial view of patient in Figure 1k. Red hexagon = ‘apple-core’ appearance of underlying cancer Figure 1n 2D coronal view of patient in Figure 1m. A = enlarged mesenteric nodes. B = mass in jejunum Figure 2a Axial 2D view showing 5.3cm abdominal aortic aneurysm. Scattered calcification in wall of aorta (red arrows). The aneurysm constitutes an urgent referral for a stenting procedure Figure 2c 2D axial view showing cyst lower pole of right kidney. An incidental finding of no clinical importance. Figure 2e 2D axial view showing umbilical hernia (green and white arrows) filled with fat. An incidental finding. Figure 2b 2D sagittal view showing large mass (red arrows) anterior to spleen and left kidney with partial calcification of wall. Adenocarcinoma of the pancreas proven on biopsy. Figure 2d 2D axial view showing multiple gallstones containing air (red square). There is no evidence of cholecystitis. Figure 2f 2D axial view showing destruction of posterior margin of the vertebral body (red circle). An important finding indicating metastasis. CASE SERIES