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

Nakashima, Kazuaki; Ishimaru, Hideki; Fujimoto, Toshifumi; Mizowaki, Takashi; Mitarai, Kazunori; Nakashima, Kei; Matsuoka, Yoshikazu; Uetani, Masataka

doi:10.1007/s00261-014-0335-2

Cited by 42 publications

(45 citation statements)

References 29 publications

(79 reference statements)

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“…Decreased or absent mural enhancement after administration of IV contrast is a useful, highly specific, indicator of intestinal ischemia (95-100%), despite variable sensitivity of 40-60% [46,57,58]. A recent meta-analysis showed that decreased mural enhancement was more predictive of ischemia than any other single CT sign [59,60]. This sign was 100% specific and 56% sensitive for bowel ischemia [57][58][59][60].…”

Section: Abdominal Ctmentioning

confidence: 91%

“…A recent meta-analysis showed that decreased mural enhancement was more predictive of ischemia than any other single CT sign [59,60]. This sign was 100% specific and 56% sensitive for bowel ischemia [57][58][59][60]. Other CT signs of ischemia include bowel wall thickening and mucosal thumbprinting from intramural edema, inflammation, or hemorrhage; pneumatosis intestinalis from intramural gas produced by bacteria; and streaky mesentery from adjacent inflammatory infiltration as listed in Table 2 [11•, 24].…”

Section: Abdominal Ctmentioning

confidence: 97%

“…CT findings of CL-SBO include radial distribution of the incarcerated bowel arranged like the rims of a bicycle wheel with mesenteric vessels converging towards a central point of torsion arranged like the spokes in a bicycle wheel, a "coffee bean," "C," or "V" loop, and the whirl sign [11•, 24]. While CL-SBO without ischemia can sometimes be managed conservatively, it usually constitutes a surgical emergency because it usually causes progressive vascular occlusion, mural ischemia, and has a high mortality, up to 35%, after delayed diagnosis for 36 h [60,74].…”

Section: Common Ct Signsmentioning

confidence: 99%

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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: Abdominal Ctmentioning

confidence: 91%

Section: Abdominal Ctmentioning

confidence: 97%

Section: Common Ct Signsmentioning

confidence: 99%

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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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“…Balthazar et al reported that the detection of ischemic change in the bowel wall, attached mesentery, or both of on CT was diagnostic of bowel ischemia [19]. Nakashima et al reported that reduced enhancements of the bowel wall and mesenteric vessels was reliable for detecting bowel ischemia [20].…”

Section: Discussionmentioning

confidence: 99%

A Study of the Prediction of Bowel Resection due to Strangulated Small Bowel Obstruction

Udaka¹,

Taniguchi²,

J³

et al. 2020

Preprint

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Background In this retrospective study, we aimed to assess the predictive factors for bowel resection due to strangulated small bowel obstruction (SSBO). Methods We enrolled a total of 109 patients diagnosed with SSBO at surgery. They were divided into two groups: those who underwent bowel resection and those who did not. The clinical findings, blood test results, blood gas analysis results, computed tomography (CT) findings, and sequential organ failure assessment (SOFA) scores of the patients were examined and compared between the two groups. Results The 109 patients were divided into the bowel resection group (n = 38) and non-bowel resection group (n = 71). A univariate analysis indicated significant predictive factors to be a history of abdominal surgery, prolonged time from the onset of disease to the operation, increased C-reactive protein (CRP) level, decreased albumin, SOFA score, existence of closed-loop obstruction, and reduced enhancement of the intestinal wall at CT. A multivariate analysis indicated that a reduced enhancement of the intestinal wall and the existence of closed-loop obstruction were independent predictive factors. Strangulated bowel obstruction can progress to a serious condition. It is therefore crucial to predict preoperatively those patients who are likely to require bowel resection. Conclusions Assessing the reduced enhancement of the intestinal wall and the existence of closed-loop obstruction are required in order to determine whether or not resection of the incarcerated intestine with SSBO is necessary.

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“…Active small bowel bleeding at multiphase CTE is observed as a gradual accumulation of contrast material within the bowel lumen [8].…”

Section: Emergencymentioning

confidence: 99%

Small Bowel Disease

Laghi

Hara

2018

IDKD Springer Series

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

Abstract: Reduced enhancements of bowel wall and mesenteric veins were good indicators of bowel ischemia or necrosis. On the contrary, engorgement of the mesenteric veins was a predictor of a viable bowel.

Cited by 42 publications

References 29 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

A Study of the Prediction of Bowel Resection due to Strangulated Small Bowel Obstruction

Small Bowel Disease

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