title: Adhesive small-bowel obstruction: value of CT in identifying findings associated with the effectiveness of nonsurgical treatment.
abstract: OBJECTIVE
  To identify computed tomographic (CT) findings that are associated with the effectiveness of nonsurgical treatment in patients with adhesive small-bowel obstruction ( SBO small-bowel obstruction ) that was initially treated medically.
  
  
  METHODS
  The local institutional review board approved this retrospective study; the informed consent requirement was waived. Multi-detector row CT studies in 159 patients (64 women, 95 men; median age, 69 years) with adhesive SBO small-bowel obstruction that was initially treated medically were reviewed retrospectively and independently by two emergency radiologists to identify numerous CT findings that could be associated with the effectiveness of nonsurgical treatment. Results were compared according to the success or failure of nonsurgical treatment. Univariate statistical analyses were performed for qualitative and quantitative data, as appropriate, and each significant parameter was entered in a multivariate logistic regression analysis. The κ statistic and correlation coefficients were used to assess interobserver agreement, as appropriate.
  
  
  RESULTS
  Nonsurgical treatment succeeded in 113 patients (71%) and failed in 46 patients (29%). At univariate analysis, an anterior parietal adhesion, a feces sign, and the lack of a beak sign were associated with successful nonsurgical treatment, whereas two beak signs or more, a whirl sign, a C- or U-shaped appearance of the bowel loop, and a high degree of obstruction were associated with nonsurgical treatment failure. At multivariate analysis, fewer than two beak signs and the presence of an anterior parietal adhesion were independent predictors of the effectiveness of nonsurgical treatment, with odds ratios of 0.27 and 0.11, respectively.
  
  
  CONCLUSIONS
  The number of beak signs and the location of the transition zone in relation to the anterior peritoneal layer are independent signs associated with the success or failure of nonsurgical treatment.
authors.affiliation: From the Departments of Radiology (I.M., A.R., C.A., F.C.D., E.P., P.T.) and Biostatistics (N.M.), Hôpital Lapeyronie, CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, Montpellier 34295, France; Department of Radiology, Fondation Hôpital Saint Joseph, Paris, France (M.Z.); and CIC Inserm 2001, University of Montpellier I, Montpellier, France (I.M., P.T.).
authors.forename: Ingrid
authors.initials: I
authors.lastname: Millet
authors.forename: Alban
authors.initials: A
authors.lastname: Ruyer
authors.forename: Chakib
authors.initials: C
authors.lastname: Alili
authors.forename: Fernanda
authors.initials: F
authors.lastname: Curros Doyon
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Pages
authors.forename: Marc
authors.initials: M
authors.lastname: Zins
authors.forename: Patrice
authors.initials: P
authors.lastname: Taourel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000628:therapy*; D007421:Intestine, Small; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000000981:diagnostic imaging* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007472:Iohexol