Diagnostic performance of MDCT in identifying closed loop small bowel obstruction

Makar, Ryan A; Bashir, Mustafa R.; Haystead, Clare M.; Iseman, Christine; Mayes, Nicholas; Hebert, Stuart; Allen, Brian C.; Bhattacharya, Syamal D.; Choudhury, Kingshuk Roy; Jaffe, Tracy A.

doi:10.1007/s00261-016-0656-4

Cited by 29 publications

(29 citation statements)

References 38 publications

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“…It is more accurate for high-grade or complete obstruction than for low-grade, partial obstruction [45]. Additionally, CT can reliably demonstrate signs of ischemia, necrosis, or perforation including mural thickening, mural enhancement, mesenteric edema, and pneumatosis intestinalis (intramural air) [46,47]. CT has 63-100% sensitivity and 61-96% specificity in identifying ischemia [48].…”

Section: Abdominal Ctmentioning

confidence: 98%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

169

111

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SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn's disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks. Classical clinical tetrad is abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation. Physical exam may reveal restlessness, acute illness, and signs of dehydration and sepsis, including tachycardia, pyrexia, dry mucous membranes, hypotension/orthostasis, abdominal distention, and hypoactive bowel sounds. Severe direct tenderness, involuntary guarding, abdominal rigidity, and rebound tenderness suggest advanced SBO, as do marked leukocytosis, neutrophilia, bandemia, and lactic acidosis. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction. Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting/characterizing SBO. SBO usually resolves with medical therapy but requires surgery, preferentially by laparoscopy, for unremitting total obstruction, bowel perforation, severe ischemia, or clinical deterioration with medical therapy. Overall mortality is 10% but increases to 30% with bowel necrosis/perforation. Key point in SBO is early diagnosis, emphasizing abdominal CT; aggressive medical therapy including rehydration, antibiotics, and nil per os; and surgery for failed medical therapy.

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Section: Abdominal Ctmentioning

confidence: 98%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

169

111

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“…Over the last decade, computed tomography has become an essential modality in evaluating patients with a possible bowel obstruction. 3 Today, MDCT has been widely used to define SBO and its complications. Generally, routine diagnosis of SBO and CLO is performed with MDCT of the abdomen and pelvis combined scanning.…”

Section: Discussionmentioning

confidence: 99%

“…The radiologic signs of CLO in CT have been discussed in previous studies. [1][2][3] Dilated U/C shaped bowel loops, bowel wall thickening, whirl sign, radial distribution of mesenteric vessels, intestinal pneumatosis, increased haziness, and finally ischemic changes in the bowel wall are the most common signs of CLO.…”

Section: Discussionmentioning

confidence: 99%

“…Multidetector computed tomography (MDCT) has very high accuracy for the diagnosis of CLO and has been shown to be valuable in demonstrating the site and the cause of the obstruction. 3 Multi-detector computed tomography could define CLO and strangulation with specific signs on multiplanar images. Most important findings of CLO in MDCT are isolated U or C shaped dilated small bowel loops, the whirl sign with the spiral appearance of the mesentery, beak sign as a sudden caliber decrease at the obstruction point, and also the radial distribution of mesenteric vessels converging towards the obstruction point.…”

mentioning

confidence: 99%

“…By the way, poor or no contrast enhancement of bowel loops, mesenteric, haziness, the presence of interloop fluid and intestinal pneumatosis are very definitive signs for CLO. 3 Multidetector computed tomography with multiplanar reformatting at a workstation provides overall evaluating of all diagnostic signs on multiplanar images. The aim of this study was to evaluate of these pathologic signs with MDCT in patients with CLO.…”

mentioning

confidence: 99%

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Multiplanar Imaging Evaluation of Specific Signs in Identifying 'Closed Loop Small Bowel Obstruction' with Multidetector Computed Tomography

Haberal¹,

Hekimoğlu²,

Kırnap³

2019

Turkiye Klinikleri J Med Sci

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

Yamada,

Aoki,

Matsuda

et al. 2024

Annals of Gastroent Surgery

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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.

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Diagnostic performance of MDCT in identifying closed loop small bowel obstruction

Abstract: The CT diagnosis of CL-SBO is complex and associated imaging findings have variable sensitivity for predicting a closed loop operative diagnosis. CT can be helpful in excluding a closed loop component in patients with SBO.

Cited by 29 publications

References 38 publications

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Multiplanar Imaging Evaluation of Specific Signs in Identifying 'Closed Loop Small Bowel Obstruction' with Multidetector Computed Tomography

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

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