• Imaging of acute small bowel pathologies in oncology patients in the ER part II: the role of computed tomography (CT) in detection of treatment-related small bowel complications

    Hajra Arshad, Satomi Kawamoto, Linda C Chu, Elliot K Fishman

    Emerg Radiol. 2025 Jun;32(3):475-482. doi: 10.1007/s10140-025-02342-5. Epub 2025 Apr 12.

    Abstract

    There is a high burden of acute abdomen presentations in oncology patients, stemming from tumor development, surgical interventions, and the side effects of treatments on the gastrointestinal tract. Chemotherapy, radiotherapy and postsurgical complications have previously been shown to affect the small bowel; however, newer modalities of cancer treatment including immunotherapy and antiangiogenic therapy have also been seen to cause bowel injury. Traditional computed tomography (CT) scans are used as the gold standard diagnostic modality. However, three-dimensional (3D) postprocessing techniques including maximal intensity projection (MIP), volume rendering (VR) and cinematic rendering (CR) have been utilized for image interpretation. For a more organized approach to describe diagnostic challenges in this complex population, we have divided the pictorial essay into two parts. The first part focused on tumor- and infection-associated causes. This second part will address treatment-related complications, including chemotherapy, radiotherapy, immunotherapy, graft-versus-host disease and post-surgical complications as summarized below.