986 Computed Tomography Features Associated With Operative Management for Nonstrangulating Small Bowel Obstruction

Suri, Rakesh R.; Vora, Parag; Kirby, John M.; Chan, Kevin C.; Smith, Stephen J.; Ruo, Leyo

doi:10.1016/s0016-5085(10)63991-1

Cited by 4 publications

(5 citation statements)

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“…1a, b). A transition point in patients with nonstrangulated SBO may be a significant predictor of operative management [62], but this finding is controversial [63]. Complete obstruction shows severely discrepant luminal diameters between proximal and distal small bowel adjacent to the transition point, with collapse of the distal small bowel and colon, and no passage of air or fluid beyond the transition point.…”

Section: Common Ct Signsmentioning

confidence: 99%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

161

111

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SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn's disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks. Classical clinical tetrad is abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation. Physical exam may reveal restlessness, acute illness, and signs of dehydration and sepsis, including tachycardia, pyrexia, dry mucous membranes, hypotension/orthostasis, abdominal distention, and hypoactive bowel sounds. Severe direct tenderness, involuntary guarding, abdominal rigidity, and rebound tenderness suggest advanced SBO, as do marked leukocytosis, neutrophilia, bandemia, and lactic acidosis. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction. Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting/characterizing SBO. SBO usually resolves with medical therapy but requires surgery, preferentially by laparoscopy, for unremitting total obstruction, bowel perforation, severe ischemia, or clinical deterioration with medical therapy. Overall mortality is 10% but increases to 30% with bowel necrosis/perforation. Key point in SBO is early diagnosis, emphasizing abdominal CT; aggressive medical therapy including rehydration, antibiotics, and nil per os; and surgery for failed medical therapy.

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Section: Common Ct Signsmentioning

confidence: 99%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

161

111

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“…Muchos estudios han intentado describir el rol de la tomografía en la predicción de cirugía en pacientes con obstrucción del intestino delgado. Un estudio encontró que el punto de transición, obstrucción intestinal completa y aire libre en la cavidad abdominal, alcanzan de forma individual especificidades del 100 %; sin embargo, su sensibilidad es menor al 70 % (15,16). Otro estudio, encontró que la combinación de la presentación de líquido intraperitoneal, edema mesentérico, ausencia de fecalización y obstrucción completa permiten predecir la necesidad de cirugía con una sensibilidad del 98 % y una especificidad del 90 % (17).…”

Section: Discussionunclassified

“…El signo de fecalización muestra una relación inversa respecto a la necesidad de intervención quirúrgica (7,(16)(17)(18)(19)(20). En nuestro estudio se observó que el signo de fecalización del intestino delgado se comportó como un factor protector sobre el desenlace, pero sin significancia estadística.…”

Section: Discussionunclassified

Factores predictores en tomografía computarizada de necesidad de cirugía en pacientes con obstrucción del intestino delgado: Estudio de cohorte

Vallejos

Guerrero

Díaz

2019

Rev. colomb. radiol.

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Antecedentes: La obstrucción del intestino delgado es una de las causas de abdomen agudo. El manejo quirúrgico suele reservarse para los casos que no responden al tratamiento conservador; sin embargo, esto puede conducir a una mayor tasa de complicaciones. Objetivo: Mediante tomografía computarizada, identificar los hallazgos de abdomen predictores de la necesidad de intervención quirúrgica en los pacientes con obstrucción del intestino delgado, del Hospital Universitario Nacional de Colombia entre el 1 mayo de 2016 y el 30 de mayo de 2018. Métodos: Se realizó un estudio observacional analítico retrospectivo tipo cohorte. Se incluyeron 55 pacientes adultos con obstrucción del intestino delgado. Se realizó un análisis estadístico descriptivo y de regresión logística. Se estimó el OR, la sensibilidad y la especificidad de los hallazgos de la tomografía para predecir la necesidad de cirugía. Resultados: Se incluyeron 55 pacientes, 22 (40 %) mujeres. La edad promedio fue de 51,75 +/- 17,8 años. La mediana de cirugías previas fue mayor en mujeres (2:1, p=0,009). Los síntomas más frecuentes fueron dolor abdominal (100 %), vómito (85,5 %) y otros síntomas mostraron frecuencia menor al 40 %. La cirugía se realizó en el 52,7 % de los pacientes. Dentro de los hallazgos tomográficos, el edema mesentérico mostró asociación con la necesidad de cirugía (OR 5,13, IC 95 %, 1,41-18,66), una especificidad de 84,6 % y una sensibilidad de 48,3 %. Conclusión: En tomografía, el edema mesentérico predice la necesidad de cirugía en pacientes con obstrucción del intestino delgado con una buena especificidad y baja sensibilidad.

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“…Supine and erect abdominal radiographs were obtained in all patients on admission, and the maximal intestinal diameter was measured. Radiological signs of intestinal obstruction included the existence of multiple gas lesions in the small intestine more than 2.5 cm in diameter, the absence of gas in the colon, the presence of multiple gas lesions in the large intestine more than 6 cm in diameter, or the absence of gas in the distal colon [4]. Patients were randomized using a random number table and allocated into two groups.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Value of Plain and Contrast Radiography, and Multi-slice Computed Tomography in Diagnosing Intestinal Obstruction in Different Locations

Liu

Sun

2015

Indian J Surg

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Early intestinal obstruction is easily misdiagnosed. Many physicians consider terminal bouton if computed tomography (CT) scan is done. However, different examinations provide diverse information and significance. This retrospective, randomized, clinical study investigated the diagnostic value of three imaging modalities for intestinal obstruction, supine and upright (or decubitus) plain abdominal radiography, contrast radiography using Gastrografin, and 64 multi-slice spiral CT (MSCT). A total 142 patients with intestinal obstruction were examined. The diagnostic accuracy of plain radiography, contrast radiography, and MSCT for detecting small bowel obstruction was 62.5, 85, and 77.5 %, for localizing the obstruction was 0, 90, and 78.75 %, and for determining the cause of obstruction was 0, 71, and 65 %, respectively. The diagnostic accuracy for detecting large bowel obstruction was 53.23, 73.17, and 92 %, and for localizing the obstruction was 38.17, 60.98, and 98 %, respectively. The diagnostic accuracy of MSCT in determining the cause of obstruction was 91 %. None of the patients administered Gastrografin experienced any adverse effects. In conclusion, MSCT has great diagnostic value in identifying the site and cause of intestinal obstruction, especially in cases of large bowel obstruction. Contrast radiography using Gastrografin was effective in diagnosing and treating small bowel obstruction, making it a beneficial adjunct to MSCT.

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986 Computed Tomography Features Associated With Operative Management for Nonstrangulating Small Bowel Obstruction

Cited by 4 publications

References 4 publications

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Factores predictores en tomografía computarizada de necesidad de cirugía en pacientes con obstrucción del intestino delgado: Estudio de cohorte

Diagnostic Value of Plain and Contrast Radiography, and Multi-slice Computed Tomography in Diagnosing Intestinal Obstruction in Different Locations

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