Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria.
OBJECTIVE
To evaluate the usefulness of known computed tomographic (CT) criteria for the differentiation of simple and strangulated small-bowel obstructions.


METHODS
CT scans of 84 patients with simple (n = 43) and strangulated (n = 41) small-bowel obstructions caused by adhesions, hernia, and volvulus were reviewed retrospectively. Diagnoses were made with surgery (n = 55) and during clinical follow-up (n = 29). CT criteria evaluated were configuration of obstructed bowel loop, target sign, bowel wall thickening and enhancement, changes in mesentery and mesenteric vasculature, and amount and attenuation of ascites.


RESULTS
CT findings that enabled the detection of strangulated obstructions were poor or no enhancement of bowel wall (sensitivity, 34%; specificity, 100%) and a serrated beak (sensitivity, 32%; specificity, 100%). When these two findings were excluded from analysis, a large amount of ascites, an unusual course of mesenteric vasculature, and diffuse engorgement of mesenteric vasculature were shown to be useful CT findings for performing multivariate regression analysis. Application of these five CT findings enabled identification of 35 (85%) of 41 patients with strangulated obstructions.


CONCLUSIONS
Detecting a combination of selected, known CT criteria increases the diagnostic accuracy of CT to enable differentiation of simple and strangulated small-bowel obstructions.
Ha
H K
HK
Department of Radiology, Asan Medical Center, University of Ulsan Medical College, Songpa-Ku, Seoul, Korea.
Kim
J S
JS
Lee
M S
MS
Lee
H J
HJ
Jeong
Y K
YK
Kim
P N
PN
Lee
M G
MG
Kim
K W
KW
Kim
M Y
MY
Auh
Y H
YH
D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006555:Hernia, Ventral / Q000000981:diagnostic imaging; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging*; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000267:Tissue Adhesions / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D003287:Contrast Media