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

Yıl 2022, Cilt: 29 Sayı: 1, 67 - 73, 01.03.2022

İlyas Dündar Cemil Goya Ensar Türko Sercan Özkaçmaz Mesut Özgökçe Fatma Durmaz Veysel Atilla Ayyıldız

https://doi.org/10.17343/sdutfd.986013

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

• 1. Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol: WJG 2012;18(42):6036.
• 2. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003;163(3):286-92.
• 3. Sood A, Midha V, Sood N, Kaushal V, Puri H. Increasing incidence of celiac disease in India. Am J Gastroenterol 2001;96(9):2804.
• 4. Soni S, Badawy S. Celiac disease and its effect on human reproduction. J Reprod Med 2010;55:3-8.
• 5. Ludvigsson JF, Reutfors J, Ösby U, Ekbom A, Montgomery SM. Coeliac disease and risk of mood disorders—a general population-based cohort study. J Affect Disord 2007;99(1-3):117-26.
• 6. Addolorato G, Di Giuda D, De Rossi G, Valenza V, Domenicali M, Caputo F, et al. Regional cerebral hypoperfusion in patients with celiac disease. Am J Med 2004;116(5):312-7.
• 7. Umeoka S, Koyama T, Togashi K, Kobayashi H, Akuta K. Vascular dilatation in the pelvis: identification with CT and MR imaging. Radiographics 2004;24(1):193-208.
• 8. Koo S, Fan C-M. Pelvic congestion syndrome and pelvic varicosities. Tech Vasc Interv Radiol 2014;17(2):90-5.
• 9. Park SJ, Lim JW, Ko YT, Lee DH, Yoon Y, Oh JH, et al. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. Am J Roentgenol 2004;182(3):683-8.
• 10. Coakley FV, Varghese SL, Hricak H. CT and MRI of pelvic varices in women. J Comput Assist Tomogr 1999;23(3):429-34.
• 11. Phillips D, Deipolyi AR, Hesketh RL, Midia M, Oklu R. Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol 2014;25(5):725-33.
• 12. 1Collin P, Vilska S, Heinonen P, Hällström O, Pikkarainen P. Infertility and coeliac disease. Gut 1996;39(3):382-4.
• 13. Meloni G, Dessole S, Vargiu N, Tomasi P, Musumeci S. The prevalence of coeliac disease in infertility. Hum Reprod 1999;14(11):2759-61.
• 14. Gasbarrini A, Torre ES, Trivellini C, De Carolis S, Caruso A, Gasbarrini et al. Spontaneous abortion and intrauterine fetal growth retardation as symptoms of coeliac disease. The Lancet 2000;356(9227):399-400.
• 15. Ferguson R, Holmes G, Cooke W. Coeliac disease, fertility, and pregnancy. Scand J Gastroenterol 1982;17(1):65-8.
• 16. McCann J, Nicholls D, Verzin J. Adult coeliac disease presenting with infertility. Ulster Med J 1988;57(1):88.
• 17. Sher K, Jayanthi V, Probert C, Stewart C, Mayberry J. Infertility, obstetric and gynaecological problems in coeliac sprue. Dig Dis 1994;12(3):186-90.
• 18. Farthing M, REES LH, Dawson A. Male gonadal function in coeliac disease: III. Pituitary regulation. Clin Endocrinol 1983;19(6):661-71.
• 19. Farthing M, Rees L, Edwards C, Dawson A. Male gonadal function in coeliac disease: 2. Sex hormones. Gut 1983;24(2):127-35.
• 20. Scholz FJ, Afnan J, Behr SC. CT findings in adult celiac disease. Radiographics 2011;31(4):977-92.
• 21. Ibukuro K, Tsukiyama T, Mori K, Inoue Y. Veins of Retzius at CT during arterial portography: anatomy and clinical importance. Radiol 1998;209(3):793-800.
• 22. Nicholson T, Basile A. Pelvic congestion syndrome, who should we treat and how? Tech Vasc Interv Radiol 2006;9(1):19-23.
• 23. Bookwalter CA, VanBuren WM, Neisen MJ, Bjarnason H. Imaging Appearance and Nonsurgical Management of Pelvic Venous Congestion Syndrome. RadioGraphics. 2019;39(2):596-608.
• 24. Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, et al. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol 2013;64(3):431-9.