Gastrointestinal Imaging

Scleroderma, small intestine

For a general description, see scleroderma gastrointestinal. Pathological changes in the small bowel in scleroderma are characterized by smooth muscle atrophy and the deposition of collagen in submucosal, muscular and serosal layers. Small bowel hypomotility is present in up to 90 % of cases.

Barium study may visualize a dilated and atonic duodenum, with reduced peristalsis, proximal to the aorticomesenteric angle with delayed passage of the contrast medium especially in the recumbent position. Small bowel lumen too may be diffusely dilated with hypomotility and extremely prolonged transit time. In addition there is a decrease in the distance between the valvulae conniventes. This change is probably secondary to asymmetrical fibrosis involving the circular muscle to a lesser degree than the longitudinal muscle. Sacculation due to smooth muscle atrophy and fibrosis accompanied by small vessel obstruction results in the formation of pseudodiverticula with broad base (Fig.1).

ALB

Fig.1

Scleroderma of the small bowel. Barium examination revealing a marked dilatation of small bowel loops with decreased distance between the plicae conniventes. Several broadly based pseudodiverticula (arrows) are present.

Scleroderma, small intestine, Fig.1