Research Article
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İnce bağırsak obstrüksiyonlu hastaların tanısında bilgisayarlı tomografi bulgularının rolü

Year 2018, Volume: 2 Issue: 2, 85 - 90, 02.07.2018
https://doi.org/10.30565/medalanya.388620

Abstract

Amaç: Bu prospektif araştırmanın amacı, ince barsak tıkanıklığı (İBT) değerlendirilmesinde bilgisayarlı tomografi (BT) bulgularının prognostik değerini araştırmaktır. 

Hastalar ve Yöntem: Akut karın ağrısı olan ve İBT araştırılmasında BT çekilen altmış hasta çalışmamıza dahil edildi. Bunlardan, 47 hasta (26 erkek; 21 kadın ve ortalama yaş; 60) nın sonuçları değerlendirildi. BT değerlendirme parametreleri olarak: mezenterik kirlenme, geçiş zonu, feces işareti, intramural hava ve intraperitoneal serbest sıvı kullanıldı. 

Bulgular: Mezenterik kirlenme, geçiş zonu ve intramural hava BT bulguları ile İBT tanısı arasında istatistiksel anlamlı ilişki bulundu (p<0.05). Bu BT bulguları İBT tanısında yüksek sensitivite ve pozitif prediktif değere (PPD) sahiptir. Mezenterik kirlenme, geçiş zonu ve intramural hava bulgularının kombinasyonu ile İBT tanısı arasında istatistiksel anlamlı bir ilişki saptandı (p<0.05). İnce barsak feces bulgusu ile intraperitoneal serbest sıvı bulgusunun İBT tanısı ile arasında istatistiksel anlamlı bir ilişki saptanmadı (p>0.05). Üç veya daha fazla BT bulgusunun beraber bulunması durumunda İBT tanısında istatistiksel anlamlı değeri olduğu saptandı (p<0.05). 













Sonuç: Mezenterik kirlenme ve geçiş zonu bulguları İBT tanısında en yüksek sensitivite ve PPD sahiptir. Mezenterik kirlenme, geçiş zonu ve intramural hava bulgularının kombinasyonu ile üç veya daha fazla BT bulgusunun beraber bulunması durumunda İBT tanısında spesifite belirgin oranda artmaktadır. 











References

  • 1. Atri M, McGregor C, McInnes M, Power N, Rahnavardi K, Law C, et al. Multidetector helical CT in the evaluation of acute small bowel obstruction: Comparison of non-enhanced (no oral, rectal or IV contrast) and IV enhanced CT. Eur J Radiol. 2009;71(1):135-40.
  • 2. Meigbow A, Balthazar E, Cho K, Medwid SW, Birnbaum B, Noz M. Bowel Obstruction: Evaluation with CT. Radiology. 1991;180(2):313-8. 3. Fukuya T, Hawes D, Lu C, Chang P, Barloon T. CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol. 1992;158(4):765-9.
  • 4. Maglinte DDT, Reyes BL, Harmon BH, Kelvin FM, Turner WW, Hage JE, et al. Reliability and Role of Plain Film Radiography and CT in the Diagnosis of Small-Bowel Obstruction. AJR Am J Roentgenol. 1996;167(6):1451-5.
  • 5. Millet I, Taourel P, Ruyer A, Molinari N. Value of CT findings to predict surgical ischemia in small bowel obstruction: A systematic review and meta-analysis. Eur Radiol 2015;25(6):1823-35.
  • 6. Sheedy SP, Earnest F, Fletcher JG, Fidler JL, Hoskin TL. CT of Small-Bowel Ischemia Associated with Obstruction in Emergency Department Patients: Diagnostic Performance Evaluation. Radiology. 2006;241(3):729-36.
  • 7. Furukawa A, Yamasaki M, Furuichi K, Yokoyama K, Nagata T, Takahashi M, et al. Helical CT in the Diagnosis of Small Bowel Obstruction. Radiographics. 2001;21(2):341-55.
  • 8. Geffroy Y, Boulay-Coletta I, Jules MC, Nakache S, Taourel P, Zins M. İncreased Unenhanced Bowel- Wall Attenuation at Multidetector CT is Highly Specific of İschemia Complicating Small-Bowel Obstruction. Radiology. 2013;270(1):159-67.
  • 9. Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, et al. Small Bowel Obstruction—Who Needs an Operation? A Multivariate Prediction Model. World J Surg. 2010;34(5):910-9.
  • 10. Kulvatunyou N, Pandit V, Moutamn S, Inaba K, Chouliaras K, DeMoya M, et al. A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery. J Trauma Acute Care Surg. 2015;79(3):393-8.
  • 11. O'Daly B, Ridgway PF, Keenan N, Sweeney KJ, Brophy DP, Hill ADK, et al. Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention. Can J Surg. 2009;52(3):201-6.
  • 12. Jones K, Mangram AJ, Lebron RA, Nadalo L, Dunn E. Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction? Am J Surg. 2007;194(6):780-4.
  • 13. Ha HK, Kim JS, Lee MS, Lee HJ, Jeong YK, Kim PN, et al. Differentiation of Simple and Strangulated Small-Bowel Obstructions: Usefulness of Known CT Criteria. Radiology. 1994;204(2):507-12.
  • 14. Komatsu I, Tokuda Y, Shimada G, Jacobs JL, Onodera H. Development of a simple model for predicting need for surgery in patients who initially undergo conservative management for adhesive small bowel obstruction. Am J Surg 2010;200(2):215-23.
  • 15. Zielinski MD, Eiken PW, Heller SF, Lohse CM, Huebner M, Sarr MG, et al. Prospective, Observational Validation of a Multivariate Small-Bowel Obstruction Model to Predict the Need for Operative Intervention. J Am Coll Surg 2011;212(6):1068-76.
  • 16. Jancelewicz T, Vu LT, Shawo AE, Yeh B, Gasper WJ, Harris HW. Predicting Strangulated Small Bowel Obstruction: An Old Problem Revisited. J Gastrointest Surg 2009;13(1):93-9.
  • 17. Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl W, Ansaloni L, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2013;8(1):42.
  • 18. Azagury D, Lui R, Morgan A, Spain D. Small bowel obstruction: A practical step-by-step evidence-based approach to evaluation, decision making, and management. J Trauma Acute Care Surg. 2015;79(4):661-8.
  • 19. Schindera ST, Nelson RC, DeLong DM, Jaffe TA, Merkle EM, Paulson EK, et al. Multi–Detector Row CT of the Small Bowel: Peak Enhancement Temporal Window—Initial Experience. Radiology. 2007;243(2):438-44.
  • 20. Frager DH, Baer JW. Role of CT in Evaluating Patients With Small-Bowel Obstruction. Seminars in Ultrasound, CT, and MRI,. 1995;16(2):127-40.
  • 21. Scaglione M, Romano S, Pinto F, Flagiello F, Farina R, Acampora C, et al. Helical CT diagnosis of small bowel obstruction in the acute clinical setting. Eur J Radiol. 2004;50(1):15-22.
  • 22. Colon MJ, Telen DA, Wong D, Divino CM. The relevance of transition zones on computed tomography in the management of small bowel obstruction. Surgery 2010;147(3):373-7.
  • 23. Pricolo V, Curley F. CT scan findings do not predict outcome of nonoperative management in small bowel obstruction: Retrospective analysis of 108 consecutive patients. International Journal of Surgery. 2016;27:88-91.
  • 24. Diaz JJ, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, et al. Guidelines for Management of Small Bowel Obstruction. J Travma. 2008;64(6):1651-64.
  • 25. Frager DH, Baer JW, Medwid SW, Rothpearl A, Bossart P. Detection of Intestinal Ischemia in Patients with Acute Small-Bowel Obstruction Due to Adhesions or Hernia: Efticacy of CT. AJR Am J Roentgenol. 1996;166(1):67-71.
  • 26. Jacobs SL, Rozenblit A, Ricci Z, Roberts J, Milikow D, Chernyak V, et al. Small bowel faeces sign in patients without small bowel obstruction. Clinical Radiol. 2007;62(4):353-7.
  • 27. Frasure S, Hildreth A, Takhar S, Stone M. Emergency department patients with small bowel obstruction: What is the anticipated clinical course? World J Emerg Med. 2016;7(1):35-9.
  • 28. Chen Y, Lui C, Hsu H, Yu C, Wang H, Fan H, et al. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction. Eur Radiol. 2015;25(4):922-31.

The role of computed tomography signs in diagnosis of patients with small bowel obstruction

Year 2018, Volume: 2 Issue: 2, 85 - 90, 02.07.2018
https://doi.org/10.30565/medalanya.388620

Abstract

Aim: The goal of this prospective study is to evaluate the prognostic impact of computed tomography (CT) signs in the analysis of small bowel obstruction (SBO). 

Patients and Method: Sixty consecutive patients with acute abdominal pain who were examined using abdominal CT to diagnose SBO were included in the study. 47 patients of them (26 male; 21 female and mean age, 60 years), were evaluated. CT evaluation parameters were mesenteric congestion, transition zone, feces sign, intramural air and intraperitoneal free fluid. 

Results: There was a statistically significant association between the SBO diagnosis and CT findings for mesenteric congestion, transition zone and intramural air (p<0.05 for all). These CT signs had greatest sensitivity and positive predictive value (PPV) in diagnosis of SBO. The combination of mesenteric congestion, transition zone and in-tramural air showed a significant association in the diagnosis of SBO (p<0.05). Small bowel feces sign and intraperitoneal free fluid findings had no statistically significant value in the diagnosis of SBO (p>0.05). When three or more CT findings were seen together, there was a statistically significant association in the diagnosis (p<0.05). 













Conclusion: Mesenteric congestion and transition zone had the highest sensitivity and PPV in diagnosing SBO. The combination of mesenteric congestion, transition zone and intramural air and the presence of three or more CT signs markedly increase the specificity in diagnosis of SBO. 

References

  • 1. Atri M, McGregor C, McInnes M, Power N, Rahnavardi K, Law C, et al. Multidetector helical CT in the evaluation of acute small bowel obstruction: Comparison of non-enhanced (no oral, rectal or IV contrast) and IV enhanced CT. Eur J Radiol. 2009;71(1):135-40.
  • 2. Meigbow A, Balthazar E, Cho K, Medwid SW, Birnbaum B, Noz M. Bowel Obstruction: Evaluation with CT. Radiology. 1991;180(2):313-8. 3. Fukuya T, Hawes D, Lu C, Chang P, Barloon T. CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol. 1992;158(4):765-9.
  • 4. Maglinte DDT, Reyes BL, Harmon BH, Kelvin FM, Turner WW, Hage JE, et al. Reliability and Role of Plain Film Radiography and CT in the Diagnosis of Small-Bowel Obstruction. AJR Am J Roentgenol. 1996;167(6):1451-5.
  • 5. Millet I, Taourel P, Ruyer A, Molinari N. Value of CT findings to predict surgical ischemia in small bowel obstruction: A systematic review and meta-analysis. Eur Radiol 2015;25(6):1823-35.
  • 6. Sheedy SP, Earnest F, Fletcher JG, Fidler JL, Hoskin TL. CT of Small-Bowel Ischemia Associated with Obstruction in Emergency Department Patients: Diagnostic Performance Evaluation. Radiology. 2006;241(3):729-36.
  • 7. Furukawa A, Yamasaki M, Furuichi K, Yokoyama K, Nagata T, Takahashi M, et al. Helical CT in the Diagnosis of Small Bowel Obstruction. Radiographics. 2001;21(2):341-55.
  • 8. Geffroy Y, Boulay-Coletta I, Jules MC, Nakache S, Taourel P, Zins M. İncreased Unenhanced Bowel- Wall Attenuation at Multidetector CT is Highly Specific of İschemia Complicating Small-Bowel Obstruction. Radiology. 2013;270(1):159-67.
  • 9. Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, et al. Small Bowel Obstruction—Who Needs an Operation? A Multivariate Prediction Model. World J Surg. 2010;34(5):910-9.
  • 10. Kulvatunyou N, Pandit V, Moutamn S, Inaba K, Chouliaras K, DeMoya M, et al. A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery. J Trauma Acute Care Surg. 2015;79(3):393-8.
  • 11. O'Daly B, Ridgway PF, Keenan N, Sweeney KJ, Brophy DP, Hill ADK, et al. Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention. Can J Surg. 2009;52(3):201-6.
  • 12. Jones K, Mangram AJ, Lebron RA, Nadalo L, Dunn E. Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction? Am J Surg. 2007;194(6):780-4.
  • 13. Ha HK, Kim JS, Lee MS, Lee HJ, Jeong YK, Kim PN, et al. Differentiation of Simple and Strangulated Small-Bowel Obstructions: Usefulness of Known CT Criteria. Radiology. 1994;204(2):507-12.
  • 14. Komatsu I, Tokuda Y, Shimada G, Jacobs JL, Onodera H. Development of a simple model for predicting need for surgery in patients who initially undergo conservative management for adhesive small bowel obstruction. Am J Surg 2010;200(2):215-23.
  • 15. Zielinski MD, Eiken PW, Heller SF, Lohse CM, Huebner M, Sarr MG, et al. Prospective, Observational Validation of a Multivariate Small-Bowel Obstruction Model to Predict the Need for Operative Intervention. J Am Coll Surg 2011;212(6):1068-76.
  • 16. Jancelewicz T, Vu LT, Shawo AE, Yeh B, Gasper WJ, Harris HW. Predicting Strangulated Small Bowel Obstruction: An Old Problem Revisited. J Gastrointest Surg 2009;13(1):93-9.
  • 17. Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl W, Ansaloni L, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2013;8(1):42.
  • 18. Azagury D, Lui R, Morgan A, Spain D. Small bowel obstruction: A practical step-by-step evidence-based approach to evaluation, decision making, and management. J Trauma Acute Care Surg. 2015;79(4):661-8.
  • 19. Schindera ST, Nelson RC, DeLong DM, Jaffe TA, Merkle EM, Paulson EK, et al. Multi–Detector Row CT of the Small Bowel: Peak Enhancement Temporal Window—Initial Experience. Radiology. 2007;243(2):438-44.
  • 20. Frager DH, Baer JW. Role of CT in Evaluating Patients With Small-Bowel Obstruction. Seminars in Ultrasound, CT, and MRI,. 1995;16(2):127-40.
  • 21. Scaglione M, Romano S, Pinto F, Flagiello F, Farina R, Acampora C, et al. Helical CT diagnosis of small bowel obstruction in the acute clinical setting. Eur J Radiol. 2004;50(1):15-22.
  • 22. Colon MJ, Telen DA, Wong D, Divino CM. The relevance of transition zones on computed tomography in the management of small bowel obstruction. Surgery 2010;147(3):373-7.
  • 23. Pricolo V, Curley F. CT scan findings do not predict outcome of nonoperative management in small bowel obstruction: Retrospective analysis of 108 consecutive patients. International Journal of Surgery. 2016;27:88-91.
  • 24. Diaz JJ, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, et al. Guidelines for Management of Small Bowel Obstruction. J Travma. 2008;64(6):1651-64.
  • 25. Frager DH, Baer JW, Medwid SW, Rothpearl A, Bossart P. Detection of Intestinal Ischemia in Patients with Acute Small-Bowel Obstruction Due to Adhesions or Hernia: Efticacy of CT. AJR Am J Roentgenol. 1996;166(1):67-71.
  • 26. Jacobs SL, Rozenblit A, Ricci Z, Roberts J, Milikow D, Chernyak V, et al. Small bowel faeces sign in patients without small bowel obstruction. Clinical Radiol. 2007;62(4):353-7.
  • 27. Frasure S, Hildreth A, Takhar S, Stone M. Emergency department patients with small bowel obstruction: What is the anticipated clinical course? World J Emerg Med. 2016;7(1):35-9.
  • 28. Chen Y, Lui C, Hsu H, Yu C, Wang H, Fan H, et al. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction. Eur Radiol. 2015;25(4):922-31.
There are 27 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Research Article
Authors

İsmail Şerifoğlu

İbrahim İlker Öz

Alptekin Tosun This is me

Mustafa Kemal Demir This is me

Publication Date July 2, 2018
Submission Date February 1, 2018
Acceptance Date March 8, 2018
Published in Issue Year 2018 Volume: 2 Issue: 2

Cite

Vancouver Şerifoğlu İ, Öz İİ, Tosun A, Demir MK. The role of computed tomography signs in diagnosis of patients with small bowel obstruction. Acta Med. Alanya. 2018;2(2):85-90.

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