Interobserver agreement on the diagnosis of bowel ischemia: assessment using dynamic computed tomography of small bowel obstruction

Abstract

There was moderate or substantial agreement for the diagnosis of small bowel ischemia between radiologists and residents. However, there was substantial agreement for the presence of closed loop obstruction.

Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction

“…Fifty-nine to eighty-four percent of CL-SBO cases had bowel ischemia or necrosis [5,7,12,19]; however, closed loops may occasionally resolve with conservative therapy [11]. The bowel with irreversible ischemia (necrosis) needs to be resected, and bowel with reversible ischemia may be preserved by alternate adhesiolysis.…”

“…A different detection rate of bowel ischemia in SBO using CT (63-100%) [5][6][7][8][9][10] and the various CT signs suggestive of ischemia has been described previously [6,7,11,12,[17][18][19][20][21][22]. It is difficult to precisely predict bowel ischemia or necrosis by solely diagnosable finding for bowel ischemia.Closed-loop small-bowel obstruction (CL-SBO) is the most common cause of bowel ischemia (59-84%) [5,7,12] and is considered a surgical emergency. Various axial CT signs are suggestive of CL-SBO, such as a U-or C-shaped configuration of the bowel loop, a radial distribution of mesenteric vessels converging toward the torsion site, a fusiform tapering of the loops (beak signs), and whirl signs [2,17].…”

“…Although CT may help determine whether immediate surgery is needed [11][12][13][14][15], CT findings are not exactly equivalent to the surgical findings [16]. A different detection rate of bowel ischemia in SBO using CT (63-100%) [5][6][7][8][9][10] and the various CT signs suggestive of ischemia has been described previously [6,7,11,12,[17][18][19][20][21][22]. It is difficult to precisely predict bowel ischemia or necrosis by solely diagnosable finding for bowel ischemia.…”

“…In particular, SBO with strangulation or bowel ischemia has a high mortality rate if the correct diagnosis and subsequent laparotomy are delayed [2][3][4]. However, the imaging diagnosis of bowel ischemia remains a considerable challenge [5][6][7][8][9][10]. Although CT may help determine whether immediate surgery is needed [11][12][13][14][15], CT findings are not exactly equivalent to the surgical findings [16].…”

“…Closed-loop small-bowel obstruction (CL-SBO) is the most common cause of bowel ischemia (59-84%) [5,7,12] and is considered a surgical emergency. Various axial CT signs are suggestive of CL-SBO, such as a U-or C-shaped configuration of the bowel loop, a radial distribution of mesenteric vessels converging toward the torsion site, a fusiform tapering of the loops (beak signs), and whirl signs [2,17].…”