Location of the transition zone in CT of small-bowel obstruction: added value of multiplanar reformations

Hodel, Jérôme; Zins, Marc; Desmottes, L.; Boulay-Coletta, I.; Jullès, M.C.; Nakache, Jean Pierre; Rodallec, M.

doi:10.1007/s00261-007-9348-4

Cited by 56 publications

(32 citation statements)

References 23 publications

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“…Isotropic image acquisition with MDCT also permits the display of highquality reformatted images in any plane, including display in the coronal and sagittal plane, which facilitates identification of the transition zone(s) and assessment of the location and configuration of the obstructed bowel loops [20].…”

Section: Mdct Techniquementioning

confidence: 99%

MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

et al. 2015

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Small bowel obstruction (SBO) accounts for a considerable proportion of emergency room visits, inpatient admissions, and surgical interventions in the United States. Multi-detector computed tomography (MDCT) plays a key role in imaging patients presenting with acute symptoms suggestive of SBO, which helps in establishing the diagnosis, elucidating the cause of obstruction, and detecting complications, such as ischemia or frank bowel necrosis and perforation. Recently, management of patients with SBO has shifted toward a more conservative approach with supportive care and nasogastric tube decompression, as the obstruction in many cases can resolve spontaneously without the need for operative intervention. However, management decisions in SBO remain notoriously difficult, relying on a combination of clinical, laboratory, and imaging factors to help stratify patients into conservative or surgical treatment. Imaging is often an important factor assisting in the decision-making process since traditional clinical signs of vascular compromise, such as acidosis, fever, leukocytosis, and tachycardia are often unreliable in predicting the need for operative intervention. Thus, it is critically important for radiologists to identify imaging features that suggest or indicated high likelihood of bowel vascular compromise in order to help optimize management prior to the development of bowel ischemia and eventually necrosis. By excluding signs of potentially ischemic or necrotic bowel on MDCT, patients may be spared unnecessary surgery, thus decreasing postsurgical complications and averting potential increase for the risk of future SBO and repeated surgery. Conversely, if imaging features indicate potential vascular compromise of the bowel wall that may lead to bowel ischemia, urgent surgical intervention may prevent progression to bowel necrosis and subsequent perforation.

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Section: Mdct Techniquementioning

confidence: 99%

MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

et al. 2015

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“…5 The main issue is to predict which patients would best benefit from nonoperative management. CT-scans provide rapid and reasonably accurate diagnostic information in patients presenting with clinical features of SBO, [21][22][23] and previous studies used water-soluble contrast medium to determine whether SBO was present and whether it was complete. The usefulness of a combination of these two procedures, especially for surgeons, has never been assessed.…”

Section: Discussionmentioning

confidence: 99%

Improving the Management of Acute Adhesive Small Bowel Obstruction with CT-Scan and Water-Soluble Contrast Medium: A Prospective Study

Trésallet

Lebreton

Royer

et al. 2009

Diseases of the Colon &Amp; Rectum

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This study demonstrated the diagnostic role of Gastrografin(R) in discriminating between partial and complete small bowel obstruction. CT-scans were disappointing in their ability to predict the necessity of emergent laparotomies. We therefore recommend the use of Gastrografin(R) in adhesive small bowel obstruction patients who do not have clinical evidence of bowel ischemia. CT-scans should not be routinely performed in the decision-making process except when clinical history, physical examination, and plain film are not conclusive for small bowel obstruction diagnosis.

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“…Excluding other reasons for impaired bowel function is important, including serious constipation due to opiates or other drugs, as well as identifying the patients who will benefi t from any procedure to reestablish bowel function. With modern diagnostic tools, such as contrast enhanced multi-detector CT scans, assessing the nature of obstruction is possible with high diagnostic accuracy in most patients [ 45 ]. The following questions should be addressed when considering palliative surgical procedures ( Fig.…”

Section: Malignant Bowel Obstructionmentioning

confidence: 99%

Surgical Treatment in Palliative Care

Kørner

Søreide

2014

Multidisciplinary Treatment of Colorectal Cancer

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Palliative surgery aims to relieve symptoms in patients with incurable disease by interventions. Traditionally, palliative surgery has been understood as non-curative surgery, i.e. non-resectional or R2 procedures, without suffi cient attention to the impact on patients' quality of life (QoL).Palliative surgical procedures are indicated to relieve -or preventsymptoms in patients with incurable disease in order to keep or improve the QoL. These interventions should fi t into the patient's general situation within the disease trajectory. Effective and empathic communication is essential to achieve a common understanding of the clinical situation, the individual treatment goals and expectations with regard to the effects of an intervention. Severe complications or any futile procedure, which may jeopardise the patient's QoL, should be prevented. Palliative surgical procedures comprise any interventions, including conventional open surgery, minimally invasive procedures and endoscopic and percutaneous techniques. Indications and benefi ts have to be evaluated by patient-reported outcomes, e.g. by validated symptom scores.

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Location of the transition zone in CT of small-bowel obstruction: added value of multiplanar reformations

Abstract: MPR can increase both accuracy and confidence in the location of the transition zone in CT of SBO.

Cited by 56 publications

References 23 publications

MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

Improving the Management of Acute Adhesive Small Bowel Obstruction with CT-Scan and Water-Soluble Contrast Medium: A Prospective Study

Surgical Treatment in Palliative Care

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