[Vascular complications in intestinal obstructions. The role of computed tomography].
BACKGROUND
We investigated CT capabilities in showing vascular complications (ischemia, infarction) secondary to intestinal obstruction.


METHODS
32 patients with small bowel obstruction, subdivided in two groups, were examined with CT. The first group consisted of 12 patients with small bowel obstruction complicated by ischemic injury. It was due to loop strangulation in 10 cases and loop distension secondary to colon carcinoma in 2 cases. At surgery the loop strangulation was caused by adhesions in 9 cases and by jejunal hernia in 1 case. Vascular complications were segmentary small bowel infarction in 7 cases, colonic infarction in 2 cases and ischemia, which was resolved after loop debridement, in 3 cases. The second group consisted of 20 patients with intestinal occlusion due to adhesions complicated by a closed loop in 4 cases. All patients were examined with(out) i.v. contrast agent administration. Filling of the intestinal loops by oral contrast agent was never performed.


RESULTS
CT identified the vascular injury secondary to intestinal obstruction in 11/12 patients (91%). In one case it was not possible to diagnose mild ischemia, which was found of surgery. CT findings were: loops distention in all the cases; wall thickening in 11 cases with intramural gas in 8 cases and slight contrast enhancement in 1 case; ascites in 2 cases; mesenteric edema in 9 cases; gas at the mesenteric root in 1 case. In the control group, small bowel obstruction was diagnosed with CT in all cases based on the presence of distended loops up to the occlusion site. Parietal alterations above the lesion were never found.


CONCLUSIONS
CT is a sensitive tool for diagnosing small bowel obstruction and for assessing the site and cause of obstruction. CT plays a pivotal diagnostic role in vascular complications, giving very important indications for a correct treatment.
Vinci
R
R
Dipartimento di Medicina Interna e Medicina Pubblica, Università degli Studi, Bari.
Angelelli
G
G
Stabile Ianora
A A
AA
Gaballo
A
A
Rotondo
A
A
D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D007415:Intestinal Obstruction / Q000150:complications* / Q000000981:diagnostic imaging*; D007420:Intestine, Large / Q000098:blood supply* / Q000000981:diagnostic imaging*; D007421:Intestine, Small / Q000098:blood supply* / Q000000981:diagnostic imaging*; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D011006:Pneumatosis Cystoides Intestinalis / Q000150:complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000150:complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
Complicazioni vascolari nelle occlusioni intestinali. Ruolo della Tomografia Computerizzata.