Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery.
OBJECTIVE
To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO).


METHODS
Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2.


RESULTS
Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018).


CONCLUSIONS
In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery.
Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA 94305-5105, USA.
Swati D
SD
Deshmukh
David S
DS
Shin
Juergen K
JK
Willmann
Jarrett
J
Rosenberg
Lewis
L
Shin
R Brooke
RB
Jeffrey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003287:Contrast Media / Q000494:pharmacology*; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media