Vascular assessment in small bowel obstruction: can CT predict requirement for surgical intervention?

Ferris, Baillie W. C.; Bastian-Jordan, Matthew; Fenwick, John D.; Hislop-Jambrich, Jacqui

doi:10.1007/s00261-020-02698-x

Cited by 7 publications

(7 citation statements)

References 15 publications

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“…Moreover, broad consensus has been reached on the value of CT imaging in assessing whether intestinal obstruction requires surgical intervention [22][23][24][25][26][27][28]. e comprehensive sensitivity and specificity are 87% and 73%, respectively, while two imaging signs are pivotal for determining whether it is necessary to perform surgical intervention, namely, local ischemia and complex signs [29]. Complex signs such as "closed loop", "beak sign", "whirl sign", "cup mouth sign", and "target sign" can be readily judged by experienced clinicians and radiologists, but it is difficult to evaluate the imaging of local bowel wall ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Complex signs such as "closed loop", "beak sign", "whirl sign", "cup mouth sign", and "target sign" can be readily judged by experienced clinicians and radiologists, but it is difficult to evaluate the imaging of local bowel wall ischemia. Relevant data indicated that delayed surgery for intestinal obstruction with bowel wall ischemia markedly increases the mortality rate [29]. At present, bowel wall thickening, bowel wall pneumatosis, bowel wall density decline, mesenteric edema, ascites, and portal venous gas and inflation are recognized as CT imaging signs of local bowel wall ischemia [30].…”

Section: Discussionmentioning

confidence: 99%

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Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction

Shi²,

Zhang³

et al. 2022

Contrast Media & Molecular Imaging

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We aimed to analyze the computed tomography (CT) imaging signs of bowel wall ischemia in patients with acute intestinal obstruction and construct an imaging prediction model to guide clinical treatment. The CT imaging signs of patients with acute intestinal obstruction diagnosed in our center in recent 6 years were collected for retrospective analysis. The etiology of intestinal obstruction and incidence rate of bowel wall ischemia were recorded, and the specific CT findings of bowel wall ischemia, including mesenteric edema, bowel wall thickening, and fish tooth sign, were analyzed. Among the 302 patients selected, 130 surgically treated patients were eligible for analysis. Bowel wall ischemia in acute intestinal obstruction showed an incidence rate of 14.90%, and the incidence rates of bowel wall ischemia in intra-abdominal hernia, intussusception, incarcerated external abdominal hernia, and volvulus were about 92.30%, 50%, 35.71%, 33.33%, and 12.59%, respectively. The incidence rate of bowel wall ischemia in simple adhesive intestinal obstruction was about 12.59%, and that in malignancy-induced intestinal obstruction was about 6.56%. Univariate analysis revealed 5 factors with statistical significance, including bowel wall thickening, mesenteric edema, bowel wall pneumatosis, ascites, and fish tooth sign. Multivariate logistic regression analysis indicated that fish tooth sign, bowel wall thickening, and mesenteric edema were able to predict bowel wall ischemia, and the corresponding partial regression coefficients were 2.164, 1.129, and 1.173, odds ratios (ORs) were 8.707, 3.093, and 3.232, sensitivity was 0.356, 0.400, and 0.844, and specificity was 0.859, 0.835, and 0.529, respectively. Imaging signs of bowel wall thickening, mesenteric edema, and fish tooth sign are valuable in predicting bowel wall ischemia, among which bowel wall thickening and mesenteric edema have relatively high specificity and fish tooth sign has a relatively high sensitivity. Furthermore, a fish tooth sign has the most favorable predictive value for bowel wall ischemia in acute intestinal obstruction, followed by bowel wall thickening and mesenteric edema.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction

Shi²,

Zhang³

et al. 2022

Contrast Media & Molecular Imaging

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“…Ultrasound criteria for the diagnosis of SBO can be divided into diagnostic and staging criteria ( Table 2 ) [ 23 ].…”

Section: Ultrasound Criteria For the Diagnosis Of Small Bowel Occlusionmentioning

confidence: 99%

“…Peristalsis alteration represents a fundamental criterion for the diagnosis of mechanical ileus [ 23 ]. In an emergency setting, there is no numerical nor quantitative parameter to evaluate kinesis, and although the evaluation is subjective, the method appears to have excellent diagnostic accuracy [ 12 , 31 , 38 ].…”

Section: Ultrasound Criteria For the Diagnosis Of Small Bowel Occlusionmentioning

confidence: 99%

“…The imaging methods used in the evaluation of a patient with suspected bowel obstruction are conventional radiology, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). CT is the gold-standard imaging modality in the diagnosis and staging of small bowel obstruction [ 20 , 21 , 22 , 23 , 24 ]. Plain abdominal X-ray in the supine and upright position has a diagnostic accuracy ranging 50–70% and has low specificity; moreover, X-rays can appear normal in patients who have complete, closed-loop, or strangulated obstructions [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound of Small Bowel Obstruction: A Pictorial Review

Rosano¹,

Gallo

Mercogliano

et al. 2021

Diagnostics

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Small bowel obstruction (SBO) is a common condition requiring urgent attention that may involve surgical treatment. Imaging is essential for the diagnosis and characterization of SBO because the clinical presentation and results of laboratory tests may be nonspecific. Ultrasound is an excellent initial imaging modality for assisting physicians in the rapid and accurate diagnosis of a variety of pathologies to expedite management. In the case of SBO diagnosis, ultrasound has an overall sensitivity of 92% (95% CI: 89–95%) and specificity of 93% (95% CI: 85–97%); the aim of this review is to examine the criteria for the diagnosis of SBO by ultrasound, which can be divided into diagnostic and staging criteria. The diagnostic criteria include the presence of dilated loops and abnormal peristalsis, while the staging criteria are represented by parietal and valvulae conniventes alterations and by the presence of free extraluminal fluid. Ultrasound has reasonably high accuracy compared to computed tomography (CT) scanning and may substantially decrease the time to diagnosis; moreover, ultrasound is also widely used in the monitoring and follow-up of patients undergoing conservative treatment, allowing the assessment of loop distension and the resumption of peristalsis.

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Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review

Eze,

Parry,

Boone

et al. 2023

Eur Radiol

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Objectives To identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction. Methods Two researchers systematically reviewed indexed literature 2001–2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies. Results Thirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36). Conclusions Systematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery. Clinical relevance statement Via systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility. Key Points • While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely. • Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery. • Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility.

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Vascular assessment in small bowel obstruction: can CT predict requirement for surgical intervention?

Cited by 7 publications

References 15 publications

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction

Ultrasound of Small Bowel Obstruction: A Pictorial Review

Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review

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