Introduction

As in any organ system, there is a veritable cornucopia of disease processes that affect the small bowel. Thus, it is important divide these diseases into manageable increments in order to effectively interpret imaging studies. At my medical school, we used the mnemonic “VINDICATES” to clump diseases into categories to include vascular, infectious/inflammatory, neoplastic, degenerative, iatrogenic/ideopathic, congenital, allergic/autoimmune, traumatic, endocrine, S-everything else. This is called a systems approach. I’m sure all of y’all have a similar way of systematically approaching differential diagnoses, and it is perfectly alright to do so with the small bowel. In fact, much of this tutorial does just that. 

However, despite the large number of diseases that affect the small bowel, the small bowel contains only a limited number of ways in which it can respond to insults. For example, the differential diagnosis list for bowel wall thickening may include several diseases from EACH of the systems listed above, a list too long for even the most creative mnemonic. In addition, imaging studies often allow for a list of differential considerations, but they rarely allow a definitive diagnosis (i.e. clinical history and physical exam findings ARE important). This idea has led to the disease pattern approach of evaluating diseases of the small bowel. The following section will offer a platform by which imaging characteristics are evaluated and integrated to develop manageable (and remember-able) differential diagnosis lists.

You may notice some redundancy between this and subsequent sections. The reason for this is that this section focuses on the disease patterns, while the following sections discuss representative diseases from each of the various systems. Feel free to incorporate this information that in any way that helps you remember it.  For brevity’s sake, we will focus our discussion in this section on the disease pattern approach to fluoroscopy. Keep in mind, however, that the same principles apply for all of the other modalities used to evaluate the small bowel.  

An example of the disease pattern approach to interpreting small bowel imaging studies.