High-Density Free Fluid on Computed Tomography: a Predictor of Surgical Intervention in Patients with Adhesive Small Bowel Obstruction

Matsushima, Kazuhide; Inaba, Kenji; Dollbaum, Ryan; Cheng, Vincent Chi-Chung; Khan, Moazzam; Herr, Keith D.; Strumwasser, Aaron; Asturias, Sabrina; Dilektaşlı, Evren; Δημητριάδης, Δημήτριος

doi:10.1007/s11605-016-3244-6

Cited by 20 publications

(10 citation statements)

References 26 publications

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“…The mesenteric fluid sign results from venous congestion and transudation of fluid across serosa from mesenteric venous outflow obstruction; the absence of the mesenteric fluid sign decreases the probability of strangulation sixfold [59]. The presence of high-density intra-abdominal fluid (>10 Hounsfield units) on CT may predict the need for surgical intervention [72].…”

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

162

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

162

111

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“…Previous studies have reported CT values of the exudative body fluids < 10 HU [ 17 ], while those of hemorrhagic peritoneal fluid range from 15 to 75 HU [ 18 ]. A recent study reported that CT values of peritoneal fluid > 10 HU in cases of SBO indicate the need for bowel resection [ 19 ]. It has been suggested that the greater the hemorrhage associated with the progression of II due to strangulation, the higher the CT values of free peritoneal fluid.…”

Section: Discussionmentioning

confidence: 99%

Prediction model for irreversible intestinal ischemia in strangulated bowel obstruction

et al. 2022

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Background Preoperatively diagnosing irreversible intestinal ischemia in patients with strangulated bowel obstruction is difficult. Therefore, this study aimed to establish a prediction model for irreversible intestinal ischemia in strangulated bowel obstruction. Methods We included 83 patients who underwent emergency surgery for strangulated bowel obstruction between January 2014 and March 2022. The predictors of irreversible intestinal ischemia in strangulated bowel obstruction were identified using logistic regression analysis, and a prediction model for irreversible intestinal ischemia in strangulated bowel obstruction was established using the regression coefficients. Receiver operating characteristic analysis and fivefold cross-validation was used to assess the model. Results The prediction model (range, 0–4) was established using a white blood cell count of ≥ 12,000/µL and the computed tomography value of peritoneal fluid that was ≥ 20 Hounsfield units. The areas of the receiver operating characteristic curve of the new prediction model were 0.814 and 0.807 after fivefold cross-validation. A score of ≥ 2 was strongly suggestive of irreversible intestinal ischemia in strangulated bowel obstruction and necessitated bowel resection (odds ratio = 15.938). The bowel resection rates for the prediction scores of 0, 2, and 4 were 15.2%, 66.7%, and 85.0%, respectively. Conclusion Our model may help predict irreversible intestinal ischemia that necessitates bowel resection for strangulated bowel obstruction cases and thus enable surgeons to recognize the severity of the situation, prepare for deterioration of patients with progression of intestinal ischemia, and select the appropriate surgical procedure for treatment.

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“…En relación con los hallazgos tomográficos, existen conclusiones variadas. Al igual que en nuestro estudio, la presencia de líquido libre en otras series 17,19,24 se ha asociado con la necesidad de manejo quirúrgico, sobre todo en pacientes que presentan líquido libre de alta densidad 25 . Hwang, et al 26 , al igual que nosotros, reportan la zona de transición como un predictor de tratamiento quirúrgico.…”

Section: Discussionunclassified

Características clínicas y tomográficas asociadas al manejo quirúrgico en pacientes con obstrucción intestinal de origen adherencial

Toto-Morales¹,

Martínez–Munive²,

Quijano–Orvañanos³

2021

CIRU

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Antecedentes: El retraso en el manejo quirúrgico de los pacientes con oclusión intestinal aumenta la morbimortalidad y los días de estancia intrahospitalaria. Objetivo: Describir las características clínicas y tomográficas de ingreso asociadas al manejo quirúrgico en pacientes con oclusión intestinal adherencial. Método: Revisamos los expedientes electrónicos de pacientes de los últimos 5 años con diagnóstico de oclusión intestinal adherencial y los dividimos según recibieran tratamiento conservador o tratamiento quirúrgico, y comparamos las variables. Resultados: Cumplieron los criterios de inclusión 162 pacientes, con una edad media de 61.5 años. El episodio capturado fue el primer episodio de oclusión intestinal en el 63% de los pacientes. Se realizó tratamiento quirúrgico al 65.4% de los pacientes (n = 106): 52.8% (n = 56) cirugía abierta y 47.2% (n = 50) cirugía laparoscópica. El análisis multivariado mostró los siguientes factores predictores de tratamiento quirúrgico:

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High-Density Free Fluid on Computed Tomography: a Predictor of Surgical Intervention in Patients with Adhesive Small Bowel Obstruction

Abstract: High-density IFF on CT was significantly associated with the need for surgical intervention in patients with ASBO. Prospective study to validate the predictive value of high-density IFF on CT will be warranted.

Cited by 20 publications

References 26 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

Prediction model for irreversible intestinal ischemia in strangulated bowel obstruction

Características clínicas y tomográficas asociadas al manejo quirúrgico en pacientes con obstrucción intestinal de origen adherencial

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