The relevance of transition zones on computed tomography in the management of small bowel obstruction

Colón, Modesto J.; Telem, Dana A.; Wong, Debbie; Divino, Celia M.

doi:10.1016/j.surg.2009.10.005

Cited by 32 publications

(14 citation statements)

References 26 publications

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“…High-grade SBO, 11,14 presence of free fluid, 13 decreased wall enhancement and fecalization, 4 as well as presence of transition point and abnormal vascular pathway 14 have all been found to be significant predictors. In the study of Colon et al, 12 similar to ours, the authors did not find the transition point to be a significant predictor. However, all of these studies and their derived predictors were retrospective in nature (except in Hwang et al 14 ) and had small sample sizes, ranging from 30 to 36 patients.…”

Section: Discussionsupporting

confidence: 69%

A multi-institution prospective observational study of small bowel obstruction

Kulvatunyou

Pandit

Sadoun

et al. 2015

Journal of Trauma and Acute Care Surgery

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Section: Discussionsupporting

confidence: 69%

A multi-institution prospective observational study of small bowel obstruction

Kulvatunyou

Pandit

Sadoun

et al. 2015

Journal of Trauma and Acute Care Surgery

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“…Characterization of the cause and type of obstruction depends on the evaluation of the number (single vs. multiple) and location of the transition zone(s), as well as the shape or location of the dilated proximal bowel loops [6,24].…”

Section: Transition Zone Evaluationmentioning

confidence: 99%

MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

et al. 2015

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Small bowel obstruction (SBO) accounts for a considerable proportion of emergency room visits, inpatient admissions, and surgical interventions in the United States. Multi-detector computed tomography (MDCT) plays a key role in imaging patients presenting with acute symptoms suggestive of SBO, which helps in establishing the diagnosis, elucidating the cause of obstruction, and detecting complications, such as ischemia or frank bowel necrosis and perforation. Recently, management of patients with SBO has shifted toward a more conservative approach with supportive care and nasogastric tube decompression, as the obstruction in many cases can resolve spontaneously without the need for operative intervention. However, management decisions in SBO remain notoriously difficult, relying on a combination of clinical, laboratory, and imaging factors to help stratify patients into conservative or surgical treatment. Imaging is often an important factor assisting in the decision-making process since traditional clinical signs of vascular compromise, such as acidosis, fever, leukocytosis, and tachycardia are often unreliable in predicting the need for operative intervention. Thus, it is critically important for radiologists to identify imaging features that suggest or indicated high likelihood of bowel vascular compromise in order to help optimize management prior to the development of bowel ischemia and eventually necrosis. By excluding signs of potentially ischemic or necrotic bowel on MDCT, patients may be spared unnecessary surgery, thus decreasing postsurgical complications and averting potential increase for the risk of future SBO and repeated surgery. Conversely, if imaging features indicate potential vascular compromise of the bowel wall that may lead to bowel ischemia, urgent surgical intervention may prevent progression to bowel necrosis and subsequent perforation.

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“…Low PPVs for other relevant CT signs, including the presence of a transition point, mesenteric oedema or a closed‐loop, are consistently noted in several studies . Surgeons should be aware of the true PPV of these signs when trying to justify operative intervention.…”

Section: Computed Tomographymentioning

confidence: 90%

Current management of adhesive small bowel obstruction

Köstenbauer

Truskett

2018

ANZ Journal of Surgery

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Small bowel obstruction is a common and significant surgical presentation. Approximately 30% of presentations will require surgery during admission. The great challenge of adhesive small bowel obstruction (ASBO) management is the early detection of silent intestinal ischaemia in patients initially deemed suitable for conservative therapy. Recent literature emphasizes the effectiveness of computed tomography enterography and water-soluble contrast studies in the management of ASBO. Low-volume undiluted water-soluble contrast has been shown to have both triage and therapeutic value in the management of ASBO. Their use has been demonstrated to reduce the need for surgery to below 20%. There has also been growing interest in clinicoradiological algorithms which aim to predict ischaemia early in the course of presentation. The aim of this review is to summarize the latest evidence and clarify previous uncertainties, specifically regarding the duration of conservative treatment, timing of contrast studies and the reliability of predictive algorithms. Based on this latest evidence, we have formulated a management protocol which aims to integrate these latest developments and formalize a strategy for best management in ASBO.

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The relevance of transition zones on computed tomography in the management of small bowel obstruction

Cited by 32 publications

References 26 publications

A multi-institution prospective observational study of small bowel obstruction

A multi-institution prospective observational study of small bowel obstruction

MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

Current management of adhesive small bowel obstruction

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