The value of computed tomographic imaging in diagnosing intestinal ischemia among patients with small bowel obstruction
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Abstract
Purpose: This study aimed to assess the value of computed tomographic (CT) imaging in diagnosing intestinal ischemia among patients with small bowel obstruction. Materials and method: The records of 146 patients with small bowel obstruction detected on 16- slice CT imaging at the Viet Duc University Hospital from August 2018 to June 2020 were analyzed retrospectively. On imaging, the signs of intestinal ischemia were described and compared with surgical reports, andsensitivity, specificity, positive and negative predictive values, and accuracy of CT imaging were calculated. Results: hernias and bands were the most common causes of bowel ischemia, accounting for 33.3% and 31.0% of the cases, respectively. Free peritoneal fluid had highest sensivity at 83.3%. Reduction or loss of bowel wall enhancement, target sign, intraluminal pneumatosis intestinalis and pneumoperitoneum all had high specificity, ranging betwee 93 to99%. Conclusion: reduction or loss of bowel wall enhancement, intraluminal pneumatosis intestinalis and pneumoperitoneum had high specificity in diagnosing intestinal ischemia; and target sign could suggestearly stage of intestinal ischemia.
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Keywords
small bowel obstruction, intestinal ischemia, intestinal necrosis, computed tomographic (CT) imaging
References
2. Zalcman M, Sy M, Donckier V, et al. Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR. Am J Roentgenol. 2000;175(6):1601-7.
3. Iacobellis F, Berritto D, Belfiore MP, et al. Meaning of free intraperitoneal fluid in small-bowel obstruction: preliminary results using high-frequency microsonography in a rat model. J Ultrasound Med. 2014;33(5):887-93.
4. Geffroy Y, Colette IB, Jullès MC, et al. Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction. Radiology. 2014;270(1):159-67.
5. Sheedy SP, Earnest 4th F, Fletcher JG, et al. CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology. 2006;241(3):729-36.
6. Maung AA, Johnson DC, Piper GL, et al. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):362-9.
7. Nakashima K, Ishimaru H, Fujimoto T, et al. Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction. Abdom imaging. 2015;40(5):1097-103.
8. Rha SE, Ha HK, Lee S-H, et al. CT and MR Imaging Findings of Bowel Ischemia from Various Primary Causes. RadioGraphics. 2000;20(1):29-42.
9. Feczko PJ, Mezwa DG, Farah MC, et al. Clinical significance of pneumatosis of the bowel wall. RadioGraphics. 1992;12(6):1069-1078.
10. Sebastià C, Quiroga S, Espin E, et al. Portomesenteric vein gas: pathologic mechanisms, CT findings and prognosis. Radiographics. 2000;20(5): 1213-24.
11. Cho KC, Baker SR. Extraluminal air. Diagnosis and significance. Radiol Clin North Am. 1994;32(5):829-44.
12. Huang X, Fang G, Lin J, et al. A Prediction Model for Recognizing Strangulated Small Bowel Obstruction. Gastroenterol Res Pract. 2018. doi:https://doi.org/10.1155/2018/7164648
13. Mallo RD, Salem L, Lalani T, et al. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg. 2005;9(5):690-4.
14. Jancelewicz T, Vu LT, Shawo AE, et al. Predicting strangulated small bowel obstruction: an old problem revisited. J Gastrointest Surg. 2009;13(1):93-9.
15. Li Z, Zhang L, Liu X, et al. Diagnostic utility of CT for small bowel obstruction: Systematic review and meta-analysis. PloS One. 2019;14(12). doi:10.1371/journal.pone.0226740.
16. Taourel PG, Deneuville M, Pradel JA, et al. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology. 1996;199(3):632-6.
17. Balthazar EJ, Birnbaum BA, Megibow AJ, et al. Closed-loop and strangulating intestinal obstruction: CT signs. Radiology. 1992;185(3):769-75.doi:10.1148/radiology.185.3.1438761.