title: Use of computed tomography in the diagnosis of bowel complications after gynecologic surgery.
abstract: OBJECTIVE
  To determine factors predictive of bowel complications after gynecologic surgery and establish the added utility of computed tomography (CT) in the diagnostic process.
  
  
  METHODS
  Patients who underwent gynecologic surgery between January 2, 2008, and December 30, 2010, who had CT scans of the abdomen, pelvis, or abdomen and pelvis within 42 days for a suspected bowel complication were identified. Logistic regression analysis was used to identify factors predictive of bowel-related complications. The diagnostic accuracy of CT was compared among patient risk groups based on clinical suspicion (pretest probability) of bowel complications.
  
  
  RESULTS
  Among 205 eligible patients, 38 (18.5%) patients had a bowel-related complication. Mean time from surgery to CT was 12.4 (10.1) days. Clinical characteristics were used to develop a clinical model that included unexpected drainage from the drain, wound, or stoma (adjusted odds ratio [OR] 26.3, 95% confidence interval [CI] 3.1-224.4, P=.003), coronary artery disease (OR 10.7, CI 1.4-80.9, P=.022), laparotomy (compared with minimally invasive surgery) (OR 4.4, CI 1.1-17.2, P=.032), and age older than 45 years (OR 2.4, CI 0.7-8.8, P=.18). Addition of CT to clinical evaluation increased the predictive ability of the model (area under the curve) from 0.73 to 0.99. Among 57 low-risk patients, three with confirmed bowel-related complications would have been missed if CT was not performed. Among 13 high-risk patients, CT sensitivity was 70%, and it was negative for bowel complications in three patients subsequently confirmed to have serious complications (one anastomotic leak, two bowel perforations).
  
  
  CONCLUSIONS
  In patients who have undergone gynecologic surgery and have a high clinical probability of a postoperative bowel-related complication, CT alone may fail to accurately identify patients with serious complications.
  
  
  METHODS
  : II.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, and the Department of Health Sciences, Division of Biostatistics and Information, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mariam M
authors.initials: MM
authors.lastname: AlHilli
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.forename: Angelica T
authors.initials: AT
authors.lastname: Garrett
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Abimbola O
authors.initials: AO
authors.lastname: Famuyide
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000209:etiology; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D007416:Intestinal Perforation / Q000000981:diagnostic imaging* / Q000209:etiology; D007813:Laparotomy / Q000009:adverse effects; D007964:Leukocytosis / Q000209:etiology; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000209:etiology
chemical_list: D003287:Contrast Media