["White bowel". A sonographic sign of intestinal lymph edema?].

AIM: We recently introduced the term "white bowel" to describe the hyperechoic appearance of the bowel wall found in a patient with HIV-associated enteropathy. The aim of this study was to describe changes of the bowel wall and to demonstrate possible causes of this phenomenon.

PATIENTS AND

METHODS

10 patients identified as showing this phenomenon were enrolled in this study. The ultrasound examinations of the patients were re-evaluated with special regard to the echogenicity of the different layers of the bowel wall, to mesenteric lymph nodes, and to thrombosis of the mesenteric vein.

RESULTS

Diagnosis in these 10 patients included: HIV-associated enteropathy aggravated by Mycobacterium avium-intracellulare infection (n = 3); endemic coeliac disease and complications arising from T-cell lymphoma (n = 2); carcinoma of the small and large intestine (n = 3); Whipple's disease (n = 2). Sonography typically showed echogenic thickening of the wall of the small intestine -- mainly of the mucosal layer. Enlarged mesenteric lymph nodes (with both hypoechoic and occasionally hyperechoic appearance) were present in the majority of cases. In 3 cases, mesenteric vein thrombosis was also demonstrable.

CONCLUSION

The "white bowel" was found in patients with different diseases. Most of the patients showed enlargement of the mesenteric lymph nodes. Lymph oedema of the bowel wall probably constitutes the main reason for this phenomenon.