The prevalence of abdominal computed tomography imaging findings in patients with inflammatory bowel disease who present to the emergency department: a systematic review and meta-analysis

Background The diagnostic yield of abdominal computed tomographic (CT) imaging for patients with inflammatory bowel disease (IBD) in the emergency department (ED) is unclear. We aimed to estimate the prevalence of IBD and non-IBD pathologies detected by CT imaging in the ED. Methods Multiple databases were systematically searched from inception until April 18, 2025. We included studies that reported abdominal CT findings among IBD patients in the ED. We estimated the prevalence of IBD and non-IBD findings using weighted proportions with 95% confidence intervals (CI). IBD-related findings were reported separately for Crohns disease (CD) and ulcerative colitis (UC), whereas non-IBD findings were pooled for both IBD subtypes. Results Overall, 19 studies were analyzed. Among patients with CD (15 studies; n = 7681 CT scans) and UC (7 studies; n = 858 CT scans), the pooled prevalence of penetrating IBD findings were low: abscesses/inflammatory masses [CD, 12% (95% CI, 10-14); UC, 3% (95% CI, 1-6)] and perforations [CD, 3% (95% CI, 2-4); UC, 1% (95% CI, 0-2)]. Rates of other IBD findings included: inflammation [CD, 43% (95% CI, 30-57); UC, 48% (95% CI, 31-65)] and obstructions [CD, 18% (95% CI, 13-23); UC, 9% (95% CI, 1-20)]. Non-IBD pathologies were uncommon: less than 5% each for pulmonary, non-IBD gastrointestinal, or genitourinary findings. Conclusion In this meta-analysis, we found low rates of serious penetrating IBD complications and non-IBD pathologies detected by abdominal CT in the ED. These findings suggest that more selective use of CT imaging in the ED may be warranted.