Computed tomography in the assessment of suspected large bowel obstruction.
BACKGROUND
The aim of this study was to assess the efficacy of computed tomography (CT) scanning in the diagnosis of acute large bowel obstruction.


METHODS
Forty-four patients (22 men; 22 women, ages 39-94 years, mean 71 years) with clinical features and abdominal radiographic findings suggesting acute large bowel obstruction (LBO) or pseudo-obstruction were examined with CT. Supine scans were obtained with i.v. contrast medium (unless contraindicated), but (in the majority) without oral contrast. Additional prone and/or decubitus scans were obtained in 33 patients when clarification of a possible transition point on the supine scan was required. CT diagnosis of LBO was made by finding a transition point +/- mass. Final diagnosis was confirmed by surgery, further imaging and/or clinical course.


RESULTS
Twenty-two patients had proven mechanical acute LBO of whom 18 had an obstructing carcinoma; 22 patients had no mechanical obstruction. Sensitivity, specificity, Positive Predictive Value, Negative Predictive Value of CT for diagnosis of mechanical LBO were each 91%. Positive and negative likelihood ratios were 10.1 and 0.1, respectively. There were two false-negative CT scans, although one of these was reported as showing segmental mural thickening. A mass was identified on 14 of 17 patients with true-positive CT, subsequently found to have carcinoma.


CONCLUSIONS
Computed tomography with additional selective prone and/or decubitus scanning is highly effective in the diagnosis of mechanical LBO. It is suggested that it replace contrast enema as the initial imaging method.
Beattie
Garth C
GC
Department of Colorectal Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
Peters
Robert T
RT
Guy
Susanne
S
Mendelson
Richard M
RM
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging*; D007420:Intestine, Large; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome