The role of multidetector computed tomography in evaluation of small bowel obstructions

Öz

Objective: The purpose of the study was to evaluate the role and additional diagnostic contribution of multi-detec­tor computed tomography (MDCT) in patients with acute abdominal pain caused by small bowel obstruction. Materials and methods: A total of 48 patients who admit­ted to our hospital with acute abdominal pain and under­went MDCT on suspicion of intestinal obstruction and had abdominal surgery between January 2012 and October 2012 were included to our study. MDCT images were in­terpreted by two experienced radiologist retrospectively. All clinical data and surgery notes also were evaluated. Patients had surgery due to penetrating or blunt abdomi­nal injury were excluded. Results: Of these 48 patients, 26 (54.1%) were male and 22 (45.9%) were female. Patients\' ages ranged 25 to 71 and mean age was 52±5.4 years. The causes of intestinal obstruction of patients were adhesions for 12 (46.1%) pa­tients, tumors for 7 (26.9%) patients, external hernias for 5 (19.2%) patients, internal hernia for 1 (3.9%) patient and intussusception for 1 (3.9%) patient. A total concordance between the MDCT findings and definitive diagnosis was found in 26 of 23 cases and the sensitivity and specifity of MDCT in the diagnosis of small bowel obstruction were found to be 88.5% and 90%, respectively. Conclusion: MDCT is a fast, effective and reliable imag­ing method for preoperative diagnosing small bowel ob­struction causes acute abdominal pain with the advantag­es of MDCT such as multi-planar and three-dimensional reformatted imaging.

Anahtar Kelimeler

• Acute abdominal pain, multi-detector com­puted tomography, small bowel obstruction

İnce barsak tıkanıklıklarının değerlendirilmesinde çok kesitli bilgisayarlı tomografinin rolü

Öz

Amaç: Bu çalışmada akut karın ağrısı nedeniyle cerrahi operasyon yapılmış ve ince barsak obstrüksiyonu (İBO) tanısı konmuş hastaların çok kesitli bilgisayarlı tomografi (ÇKBT) bulguları retrospektif olarak incelenerek bu grup hastalarda ÇKBT\'nin tanıya katkısı değerlendirilmiştir. Gereç ve yöntem: Çalışmamıza Ocak 2012 ile Ekim 2012 tarihleri arasında hastanemize akut karın ağrısı şi­kayeti ile başvurmuş olup intestinal obstrüksiyon ön ta­nısıyla ÇKBT çekilmiş ve cerrahi tedavi uygulanmış 48 hasta dahil edildi. Hastalara ait ÇKBT görüntüleri, tüm kli­nik bilgileri ve cerrahi notları retrospektif olarak incelendi. Hastaların kesin tanıları cerrahi ve histopatolojik sonuçla­ra göre kondu. Penetran yada künt yaralanmalara bağlı opere edilen hastalar çalışma dışı bırakıldı. Bulgular: Toplam 48 hastadan, erkek hasta sayısı 26 (%54,1), kadın hasta sayısı 22 (%45,9) idi. Yaşları 25 ile 71 arasında değişen hastaların yaş ortalaması 52±5.4 yıl idi. Hastaların İBO nedenleri; 12 (%46,1) hastada adez­yonlar, 7 (%26,9) hastada tümörler, 5 (%19,2) hasta­da eksternal herniler, 1 (%3,9) hastada internal herni, 1 (%3,9) hastada invajinasyon olarak belirlendi. Kesin tanı­sı İBO olarak belirlenen 26 hastanın 23\'üne radyolojik ola­rak İBO tanısı konmuş olup ÇKBT\'nin sensitivitesi %88,5, spesifitesi %90 olarak saptandı. Sonuç: ÇKBT, multiplanar ve üç boyutlu reformat gö­rüntülerin de katkısı ile, akut karın ağrısına neden olan İBO\'ların preoperatif tespitinde hızlı, etkin ve güvenilir bir görüntüleme yöntemidir.

Anahtar Kelimeler

• Akut karın ağrısı, çok kesitli bilgisa­yarlı tomografi, ince barsak obstrüksiyonu

Kaynakça

1. Urban BA, Fishman EK. Tailored helical CT evaluation of acute abdomen. Radiographics 2000;20:725-49.
2. Max P. Rosen, Daniel Z. Sands, et al. Impact of Abdominal CT on the management of patients presenting to the emer- gency department with acute abdominal pain. Am J Roent- genol 2000;174:1391-6.
3. Fishman EK. High-resolution three-dimensional imaging from subsecond helical CT data sets: applications in vascu- lar imaging. AJR Am J Roentgenol 1997;169:441-3.
4. Zorger N, Schreyer AG. Multidetector computed tomogra- phy in abdominal emergencies. Radiologe 2009;49:523-32.
5. Silva AC, Pimenta M, Guimaraes L S. Small bowel obstruc- tion: what to look for. Radiographics 2009;29:423-9.
6. Torreggiani WC, Harris AC, Lyburn ID, et al. Computed to- mography of acute small bowel obstruction: pictorial essay. Can Assoc Radiol J 2003;54:93-9.
7. Peck JJ, Milleson T, Phelan J. The role of computed to- mography with contrast and small bowel follow-through in management of small bowel obstruction. Am J Surg 1999;177:375-8.
8. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastro- enterology 2000;118:954-68.

9. Meigbow AJ, Balthazar EJ, Cho KC, Medwid SW, Birnbaum BA, Noz ME. Bowel Obstruction: Evaluation with CT. Ra- diology 1991;180:313-8.
10. Frager D, Medwid SW, Baer JW, Mollineli B, Friedman M. CT of small bowel obstruction: value in establishing the diagnosis and determining the degree and cause. Am J Roentgenol 1994;162:37-41.
11. Furukawa A, Yamasaki M, Takahashi M, et al. CT diagnosis of small bowel obstruction: scaning technique, interpreta- tion and role in the diagnosis. Seminars in Ultrasound, CT, MRI 2003;24:336-52.
12. Balthazar EJ. CT of small bowel obstruction. Am J Roent- genol 1994;162:255-61.
13. Fukuya T, Hawes DR, Lu CC, Chang PJ, Barloon TJ. CT Diagnosis of Small-Bowel Obstruction: Efficacy in 60 Pa- tients. Am J Roentgenol 1992;158:765-9.
14. Hodel J, Zins M, Desmottes L, et al. Location of the transi- tion zone in CT of small-bowel obstruction: added value of multiplanar reformations. Abdom Imaging 2007;10:1007- 14.
15. Filippone A, Cianci R, Grassedonio E, Di Fabio F, Storto ML. Four-section multidetector computed tomographic imaging of bowel obstruction: usefulness of axial and coronal plane combined reading. J Comput Assist Tomogr 2007;31:499-507.
16. Wang Q, Chavhan GB, Babyn PS, et al. Utility of CT in the diagnosis and management of small-bowel obstruction in children. Pediatr Radiol 2012 Oct 3. [Epub ahead of print].