Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings

Kuang, Lian-Qin; Zhao, Debin; Cheng, Cheng; Wang, Yi

doi:10.1155/2016/6569103

Cited by 13 publications

(8 citation statements)

References 23 publications

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“…For evaluating whether SBO was present and obstruction severity, there were no differences among the three protocols with respect to diagnostic self-confidence, agreement, detection rate, and accuracy. These results are consistent with previous findings[5,6,13,14,19,20] and suggest that the conventional axial and coronal reformations may be sufficient to evaluate whether SBO is present and the obstruction severity without the need for additional post-processing techniques.…”

Section: Discussionsupporting

confidence: 92%

Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations

Kuang

Tang

et al. 2019

WJG

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BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography (MDCT) examination of patients with small bowel obstruction (SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques. AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia. METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients’ MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence, agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia. RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3 ( P < 0.01), but the results of the two readers using the same protocol were not different ( P > 0.05). Using protocol 3, both readers added multiple post-processing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1 ( P < 0.01), but no difference was detected between protocols 2 and 3 ( P > 0.05). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia. CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.

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Section: Discussionsupporting

confidence: 92%

Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations

Kuang

Tang

et al. 2019

WJG

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“…Apart from indigestible food consumption or presence of foreign objects, many risk factors have also been described that facilitate the development of bezoars, including diabetes mellitus, hypothyroidism, inability to chew food, history of abdominal surgery, gastrointestinal dysfunction, and drugs [ 4 , 5 ]. Although a bezoar can enter the small intestine, incarceration may occur when the diameter of a bezoar is >2.5 cm, thereby causing small bowel obstruction [ 6 ]. It is worth noting that in one of our pediatric cases, small bowel obstruction occurred due to the presence of a 2.0 cm diameter bezoar, indicating that the presence of the obstruction caused by bezoars may be related to individual differences among patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of the Curative Effect of a Transnasal Ileus Tube in the Treatment of Small Bowel Obstruction Caused by a Phytobezoar

Lin

Wang

Liang

et al. 2020

Gastroenterology Research and Practice

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Objective. To investigate the curative effect of a transnasal ileus tube in the treatment of small bowel obstruction caused by a phytobezoar. Methods. Seventy-one patients with small bowel obstruction caused by a phytobezoar who underwent treatment in three provincial tertiary grade A hospitals in Fujian Province from March 2011 to February 2020 were included in this study. Patients were divided into the following two groups according to the treatment received: (1) conservative group, comprising patients who received medical conservative treatment, and (2) combined group, including patients who received combined medical conservative treatment and transnasal ileus tube placement. The clinical symptoms, changes in abdominal imaging, tube depth of the first day, reduction of pressure volume on the first day after catheterization, length of hospital stay, and nonsurgical rate were compared between the combined and conservative groups. Results. There was no significant difference in age, sex, history of previous abdominal surgery and abdominal radiotherapy, symptoms at admission, duration of symptoms before admission, signs at admission, laboratory data, and obstruction position between the combined and conservative groups. There was a statistically significant difference in the nonsurgical rate (19/24 vs. 23/47, P = 0.014 ) between the combined and conservative groups. Logistic analysis showed that the duration of symptoms before admission, albumin level, and use of a transnasal ileus tube might be independent factors affecting the transition to surgery for patients with small bowel obstruction caused by a phytobezoar ( P < 0.05 ). Conclusion. Timely conservative medical treatment with transnasal ileus tube placement can effectively improve the nonsurgical rate of small bowel obstruction caused by a phytobezoar. The duration of symptoms before admission, albumin level, and use of a transnasal ileus tube were closely related to whether patients with small bowel obstruction caused by phytobezoar were transferred to surgery.

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“…They can be seen with abdominal radiography, ultrasonography, or CT as a mass or a filling defect. A recent study of bezoars in China by Kuang et al examined risk factors for small bowel obstruction caused by bezoars and found that major diameter measured on CT scans was a significant independent predictor [ 7 ]. In general, bezoars most commonly occur in the distal small intestine or the jejunum and in some cases, are associated with Meckel's diverticula in the ileum [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study of bezoars in China by Kuang et al examined risk factors for small bowel obstruction caused by bezoars and found that major diameter measured on CT scans was a significant independent predictor [ 7 ]. In general, bezoars most commonly occur in the distal small intestine or the jejunum and in some cases, are associated with Meckel's diverticula in the ileum [ 7 ]. The radiographic appearance of the bezoar on CT scan may be similar to the fecalized small bowel content seen with established small bowel obstructions ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

Phytobezoar: A Brief Report with Surgical and Radiological Correlation

Hirji

Robertson

Chao

et al. 2018

Case Reports in Surgery

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Gastrointestinal bezoars, collections of incompletely digested material within the alimentary tract, can present as a diagnostic challenge and should be considered in the differential diagnosis and management of small bowel obstruction, ischemic bowel, or bowel perforation. We present a case of a 37-year-old man with a distant history of laparotomy for superior mesenteric artery thrombosis requiring partial small bowel resection of the jejunum who presented with worsening abdominal pain, nausea, vomiting, and hematemesis. An abdominal computed tomography revealed dilated loops of small bowel with a transition point at the ileum, distal to his prior bowel anastomosis. He was managed initially nonoperatively, but persistent vomiting and worsening distention necessitated urgent exploratory laparotomy. During the procedure, a 4 cm by 3 cm phytobezoar was discovered at the midjejunum. The patient had an unremarkable postoperative course with no further symptoms at 1-year follow-up. Timely diagnosis and treatment of bezoar is essential to minimize patient complications.

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Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings

Cited by 13 publications

References 23 publications

Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations

Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations

Clinical Analysis of the Curative Effect of a Transnasal Ileus Tube in the Treatment of Small Bowel Obstruction Caused by a Phytobezoar

Phytobezoar: A Brief Report with Surgical and Radiological Correlation

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