Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction

Donckier, Vincent; Closset, Jean; Gansbeke, Daniel Van; Zalcman, Marc; Sy, Marième; Houben, Jean-Jacques; Lambilliotte, Jean-Pierre

doi:10.1046/j.1365-2168.1998.00813.x

Cited by 92 publications

(48 citation statements)

References 17 publications

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“…A number of large, retrospective series have reported success with nonoperative management in patients without signs of strangulation, followed by surgery carried out only in selected patients [2,3,5,8,10,19]. However, predictors to clinically discern which patients have early reversible ischemia and clinical indicators of impending strangulation have been found to be inconsistent and unreliable [3,5,9,10,20]. Therefore, there should be a role of the use of CT in the prediction for the need of subsequent surgery in patients with equivocal symptoms of strangulation.…”

Section: Discussionmentioning

confidence: 91%

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: Discussionmentioning

confidence: 91%

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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“…Spiralling of the branches of the twisted superior mesenteric artery produces a ‘barber pole’ appearance that suggests the diagnosis. Finally, CT combines in a single study the information that can be obtained by the other means, presents different signs for volvulus, and its complications and can assess ischemia at a sub-clinical stage [15, 16]. CT is the most expedient and noninvasive means for the early diagnosis of volvulus demonstrating the characteristic whirled pattern about the mesenteric vascular pedicle and tortuous vessels in the mesentery as well as the peacock’s tail sign due to torsion of the bowel around the mesenteric axis.…”

Section: Discussionmentioning

confidence: 99%

Novel Operative Management of Primary Mesenteric Volvulus

2001

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“…CT has dramatically improved the management of patients with suspected obstruction, although its accuracy varies [12].…”

Section: Laboratory and Radiologic Examinationsmentioning

confidence: 99%

Intestinal Obstruction and Perforation – The Role of the Surgeon

Dervenis

Delis

Filippou

et al. 2003

Dig Dis

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Intestinal obstruction and perforation are always a challenge for the surgeon, not only in respect to the surgical option offered to the patient, but also to the ability to accurately diagnose and stage the disease. The understanding of the underlying pathophysiological mechanism is also very important in order to classify each patient in order to receive the more appropriate treatment. Mechanisms of obstruction and perforation, methods of diagnosis as well as prevention and treatment of the disease were reviewed.

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Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction

Abstract: CT is useful for the evaluation of adhesive small bowel obstruction, to detect accurately patients with complications who require urgent operation and to determine the location of the adhesion, which represents a significant prognostic factor for success of conservative treatment.

Cited by 92 publications

References 17 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

Novel Operative Management of Primary Mesenteric Volvulus

Intestinal Obstruction and Perforation – The Role of the Surgeon

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