CT Analysis of Intestinal Obstruction due to Adhesions

Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction

“…A meta-analysis by Mallo et al of 15 separate studies found CT to be 83% sensitive (range, 63-100%) and 92% specific (range, 61-100%) for selecting patients with ischemic bowel in the setting of SBO [13,18]. There have been various CT findings reported to be helpful for diagnosing bowel ischemia [2,5,8,11,12,14,27,28]; however, some of the markers are debatable, and there has been no solely diagnosable finding. Furthermore, only a few reports refer to the difference in CT findings between bowel ischemia and necrosis [3,5,19].…”

“…Although CT may help determine whether immediate surgery is needed [11][12][13][14][15], CT findings are not exactly equivalent to the surgical findings [16]. A different detection rate of bowel ischemia in SBO using CT (63-100%) [5][6][7][8][9][10] and the various CT signs suggestive of ischemia has been described previously [6,7,11,12,[17][18][19][20][21][22]. It is difficult to precisely predict bowel ischemia or necrosis by solely diagnosable finding for bowel ischemia.…”

“…In particular, SBO with strangulation or bowel ischemia has a high mortality rate if the correct diagnosis and subsequent laparotomy are delayed [2][3][4]. However, the imaging diagnosis of bowel ischemia remains a considerable challenge [5][6][7][8][9][10]. Although CT may help determine whether immediate surgery is needed [11][12][13][14][15], CT findings are not exactly equivalent to the surgical findings [16].…”

CT Evaluation of Small Bowel Obstruction

“…In advanced cases, pneumatosis intestinalis may develop. Although ascites may be present in patients with closed-loop obstruction without ischemia or with simple bowel obstruction (9,10), it is more commonly seen in patients with strangulation and should be considered a suspicious finding.…”

Non-traumatic abdominal emergencies: imaging of acute intestinal obstruction

“…Closed-loop obstruction: CT shows [24,25,26,27] findings of incarcerated small bowel with radial distribution and stretched mesenteric vessels converging toward torsion and a U-or C-shaped dilated bowel loop and at the site of torsion, the presence of two adjacent collapsed, round, oval, or triangular loops, the beak sign appearing as a fusiform tapering when the bowel is imaged in longitudinal section and a whirl sign, meaning a twist of the mesentery. 2.…”