Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities

Burkill, Guy; Bell, James; Healy, Jeremiah C.

doi:10.1007/s003300100882

Cited by 36 publications

(23 citation statements)

References 64 publications

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“…Small-bowel obstruction (SBO) is a common surgical condition accounting for as many as 12-16% of surgical admissions annually [1][2][3][4][5][6]. Recently, it has been generally accepted that patients with an SBO should be aggressively resuscitated during a 12-to 24-h period, except when the patient is in frank septic shock [2,3,5].…”

Section: Introductionmentioning

confidence: 99%

Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion

Hwang

Lee

et al. 2009

Eur Radiol

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The aim of this study was to evaluate the value of use of multidetector CT (MDCT) to predict the need for subsequent surgery in patients with small-bowel obstruction (SBO) due to adhesion. During a 3-year period, 128 patients with an SBO due to adhesion were enrolled in this prospective study. Initially, all patients were treated conservatively. Surgery was performed in patients who developed signs of strangulation or did not improve, despite a conservative treatment for at least 5 days. Of the 128 patients, 37 patients eventually underwent surgery. Two radiologists interpreted MDCT findings regarded as predictive indicators for subsequent surgery in consensus. The findings included degree of SBO, presence of transition zone, and an abnormal vascular course. These findings were statistically compared between the group operated on and the group not operated on. A higher degree of SBO, an abnormal vascular course, and the presence of transition zone were more frequently seen in the group of patients operated on (p < 0.001). Sensitivities, specificities, positive and negative predictive values, and risks for the use of MDCT to predict the need for surgery were 100%, 46.1%, 43%, 100%, and 1.9 (1.5 < or = 95% confidence interval (CI) < or = 2.2) for a high-grade obstruction; 100%, 23%, 34.5%, 100%, and 1.3 (1.2 < or = 95% CI < or = 1.5) for the presence of a transition zone; and 70.2%, 90.1%, 74.2%, 88.1%, and 7.1 (3.7 < or = 95% CI < or = 13.7) for the presence of an abnormal course of the mesenteric vessels, respectively. The presence of a high degree of SBO and an abnormal vascular course around transition zone are useful indicators on MDCT to predict the need for surgery in patients with an SBO due to adhesion.

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Section: Introductionmentioning

confidence: 99%

Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion

Hwang

Lee

et al. 2009

Eur Radiol

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“…Computed tomography assessment is effective, with a sensitivity of 83%-100% and specificity of 61%-93%. 3 In patients with nonstrangulating SBO, there are limited data on whether CT may help predict which patients will require surgical intervention. While a sur geon's decision to operate ultimately depends on the patient's clinical condition, CT features predictive for operative management of patients with nonstrangulating SBO may facilitate care.…”

Section: Discussionmentioning

confidence: 99%

“…Based on a review of the literature for commonly described CT radiographic features in patients with SBO and at the recommendation of a body radiologist, we evaluated 9 CT features: ascites, beak sign, complete bowel obstruction, internal hernia, diameter at point of maximal small bowel dilation (in centimetres), small bowel feces sign, target sign, transition point and whirl sign. 1,3,11,12 Definitions of these features are provided in Table 1, with selected illustrations in Figure 1. Two radiologists (P.V.…”

Section: Patientsmentioning

confidence: 99%

“…2 Most radiographic methods are currently unable to predict which patients will benefit from early surgery; rather, they may illustrate strangulation once this has occurred. 3 One exception is the administration of oral gastrograffin, as its appearance in the colon 24 hours after administration has been shown to suc cessfully predict the nonoperative resolution of SBO. 4 The role of computed tomography (CT) in predict ing the need for surgical intervention in patients with nonstrangulating SBO is currently under active investi gation.…”

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confidence: 99%

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

Suri¹,

Vora²,

Kirby³

et al. 2010

Gastroenterology

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“…CT scan sensibility for high-grade obstruction is about 90%, for low-grade obstruction approximately 50% [6,16]. CT is superior in comparison with abdominal X-ray, ultrasonography and MRI for locating the site of obstruction and diagnosis of bowel ischemia [15,18].…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

Intestinal Obstruction and Perforation – The Role of the Gastroenterologist

Dítě

Lata

Novotný³

2003

Dig Dis

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Intestinal obstruction belongs to highly severe conditions in gastroenterology, namely from the viewpoint of quick and correct diagnosis as well as at determining rational and effective therapy. Etiological multifactorial characteristics leading to processes resulting in mechanical or dynamic obstruction of the intestine, often referred to as paralytic ileus, are undoubtedly serious factors influencing the accuracy of diagnosis and therapeutic approach. Digestive endoscopy is a mandatory method in the diagnosis of intestinal obstructions. Diagnostic endoscopy, colonoscopy in the involvement of the large intestine or enteroscopy in the case of incomplete obstruction of the small intestine are the methods indicated in the majority of obstructive intestinal lesions. Besides their diagnostic importance, they also enable an effective therapeutic approach which may immediately follow the diagnostic intervention. Besides endoscopy that – due to the nature of performance – belongs to invasive methods, the diagnosis of obstructive intestinal processes is unthinkable without the use of non-invasive imaging methods. Abdominal ultrasound examination, a widely applied method, provides – under optimal examination conditions – information, e.g., about the width of the intestinal lumen or about the intestinal wall thickness; however, the specificity of investigation is not always sufficient. Both specificity and sensitivity of exploration are increased by a plain X-ray of the abdomen supplementing the ultrasound examination. Better results are achieved when the abdominal cavity is inspected by means of spiral CT examination that is nowadays not fashionably but highly effectively applied in the modification of the so-called CT enteroclysis or CT colonography. The usage of magnetic resonance (e.g. virtual colonography) is similar, but its efficacy is lower than that of CT examination. From a gastroenterologist’s perspective, endoscopic examination is the fundamental diagnostic and therapeutic method. However, endoscopic examination is initially limited by the cardiopulmonary state of the patient – in a number of cases, first the cardiopulmonary condition must be stabilized, dysbalance of water and mineral state must be restored, and only then can endoscopic investigation be carried out. The application of enteroscopy in small intestine disorders is only suitable in cases where air must be aspirated from the region of the stomach and mainly small intestine as it happens, for example, in acute intestinal pseudo-obstruction. The success of complex conservative therapy in these states is reached in 80% of the cases. In acute and complete intestinal obstruction, a surgical treatment performed in time is the only method. In these cases, the importance of identification of obstruction and timing of the intervention performance from the viewpoint of the patient’s survival is explicitly the principal and life-saving concern. In acute intestinal obstructions developing in patients with malignant affection of the intestine, it is necessary t...

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Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities

Cited by 36 publications

References 64 publications

Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion

Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion

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

Intestinal Obstruction and Perforation – The Role of the Gastroenterologist

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