Diagnosis of necrotic and non‐necrotic small bowel strangulation: The importance of intestinal congestion

Abstract

BackgroundDespite the prevalence of laparoscopic techniques in abdominal surgeries today, bowel obstruction remains a potentially serious complication. Small bowel strangulation (SBS), in particular, is a critical condition that can lead to patient mortality. However, the prognosis for SBS is favorable if surgery is performed before the onset of necrosis. Non‐necrotic SBS is a reversible condition in which blood flow can be restored by relieving the strangulation. The purpose of this study was to identify sensitive and specific contrast‐enhanced computed tomography (CT) findings that are useful for diagnosis of both non‐necrotic and necrotic SBS.MethodsWe included patients diagnosed with SBS and simple bowel obstruction (SBO) who underwent contrast‐enhanced CT followed by surgery from 2006 to 2023. Two gastrointestinal surgeons independently assessed the images retrospectively.ResultsEighty SBO and 141 SBS patients were included. Eighty‐seven had non‐necrotic SBS and 54 had necrotic SBS. Mesenteric edema was most frequently observed in both necrotic and non‐necrotic SBS cases followed by abnormal bowel wall thickening. These two findings were observed significantly less frequently in SBO. Bowel hypo‐enhancement is identified in only about half of the non‐necrotic SBS cases, and it was detected at significantly higher rates in necrotic SBS compared to non‐necrotic.ConclusionMesenteric edema and abnormal bowel wall thickening are sensitive and specific signs of both non‐necrotic and necrotic SBS. These two findings indicate mesenteric and bowel congestion. Detecting intestinal congestion can lead to an accurate diagnosis of SBS, particularly in case of non‐necrotic SBS, where bowel hypo‐enhancement may sometimes be absent.