EVALUATION OF PELVIC VENOUS DILATATION WITH COMPUTED TOMOGRAPHY IN PATIENTS WITH CELIAC DISEASE

Öz

Objective Celiac disease (CD) is characterized by an immune response in genetically gluten-sensitive individuals resulting in inflammatory damage of the small intestine. The radiological identification of pelvic venous dilatation (PVD) is important as it can contribute to the diagnosis of different spectrums of pelvic and systemic diseases. In our study, we aimed to determine the prevalence of PVD in CD patients and to present our findings with the literature. Materials and Methods This retrospective observational study was approved by the institutional review board in our institution. All patients were patients diagnosed with CD by clinical evaluation, serological data, and intestinal biopsy, and who underwent CT between October 2011 and March 2020 in our medical center. CD patients (n=149) and control group (n=250) who had contrastenhanced CT were evaluated for PVD. In all patients, PVD prevalence was examined in the patient and the control group. The diameter of the pelvic veins was measured and noted. Complaints of the patients were noted from the hospital records. Results Among a total of 149 histopathologically proven patient groups, there were 93 female and 56 male patients with a mean age of 35.11±13.03 and 36.23±15.06 years, respectively. Among a total of 250 control groups; there were 145 females and 105 males with a mean age of 38.65±15.38 and 37.25±13.56 years, respectively. PVD prevalence in the female and male were 60.22% (n=56) and 41.07% (n=23) in CD patients, respectively. 46.75% (n=36) CD patients had abdominal pain and were correlated with PVD (p<0.05). Mesenteric engorgement and small bowel fold abnormalities were correlated with PVD (p<0.05). Conclusions Pelvic congestion syndrome is one of the causes of chronic pelvic pain thought to be caused by PVD, which is very common in women and can potentially lead to significant disability. Abdominal pain is an important reason for the application of imaging methods in CD. In our study, abdominal pain with CD patients was correlated with PVD. Also, the prevalence of PVD was considerably high. Therefore the increased prevalence of PVD seen on contrast-enhanced CT in CD patients may be a component of pelvic complaints.

Anahtar Kelimeler

• pelvic venous dilatation
• coeliac disease
• computed tomography

ÇÖLYAK HASTALARINDA PELVİK VENÖZ DİLATASYONUNUN BİLGİSAYARLI TOMOGRAFİ İLE DEĞERLENDİRİLMESİ

Öz

Amaç Çölyak hastalığı (ÇH), genetik olarak glutene duyarlı bireylerde, ince bağırsağın enflamatuar hasarına yol açan bir immün yanıt ile karakterizedir. Pelvik venöz dilatasyonun (PVD) radyolojik olarak tanımlanması, pelvik ve sistemik hastalıkların farklı spektrumlarının teşhisine katkıda bulunabileceğinden önemlidir. Çalışmamızda ÇH olanlarda PVD prevalansını belirlemeyi ve bulgularımızı literatür eşliğinde sunmayı amaçladık. Gereç ve Yöntem Bu retrospektif gözlemsel çalışma, kurumumuzdaki etik kurulu tarafından onaylandı. ÇH tanısı alan tüm hastalar, klinik değerlendirme, serolojik veriler ve bağırsak biyopsisi olan ve Ekim 2011-Mart 2020 tarihleri arasında tıp merkezimizde Bilgisayarlı Tomografisi (BT) çekilen hastalardı. Kontrastlı BT yapılan ÇH olanlar (n=149) ve kontrol grubu (n=250) PVD açısından değerlendirildi. Hasta ve kontrol grubundaki tüm hastalarda PVD prevalansı incelendi. Pelvik damarların çapı ölçüldü ve not edildi. Hastaların şikayetleri hastane kayıtlarından not edildi. Bulgular Histopatolojik olarak kanıtlanmış toplam 149 hasta grubunda, yaş ortalaması sırasıyla 35,11 ± 13,03 ve 36,23 ± 15,06 yıl olan 93 kadın ve 56 erkek hasta vardı. Toplam 250 kontrol grubu arasından; yaş ortalaması sırasıyla 38,65 ± 15,38 ve 37,25 ± 13,56 yıl olan 145 kadın ve 105 erkek vardı. Kadın ve erkekte PVD prevalansı ÇH’larında sırasıyla %60,22 (n=56) ve %41,07 (n=23) idi. ÇH’nın %46,75’inde (n=36) karın ağrısı vardı ve PVD ile korele idi (p < 0.05). Mezenterik engorjman ve ince bağırsak kıvrım anormallikleri PVD ile korele idi (p < 0,05). Sonuç Pelvik konjesyon sendromu, kadınlarda çok yaygın olan ve potansiyel olarak önemli sakatlıklara yol açabilen PVD'nin neden olduğu düşünülen kronik pelvik ağrının nedenlerinden biridir. Karın ağrısı, ÇH'de görüntüleme yöntemlerinin uygulanmasının önemli bir nedenidir. Çalışmamızda ÇH hastalarında karın ağrısı PVD ile korele idi. Ayrıca, PVD prevalansı oldukça yüksekti. Dolayısıyla, ÇH olanlarda kontrastlı BT'de görülen artmış PVD prevalansı pelvik şikayetlerin bir bileşeni olabilir.

Anahtar Kelimeler

• pelvik venöz dilatasyon
• çölyak hastalığı
• bilgisayarlı tomografi

Kaynakça

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