title: Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction.
abstract: OBJECTIVE
  The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO).
  
  
  METHODS
  We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air-fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared.
  
  
  RESULTS
  A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, -59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < -11.75 HU predicted phytobezoar impaction.
  
  
  CONCLUSIONS
  MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces.
  
  
  CONCLUSIONS
  • MDCT examination helps to differentiate phytobezoar and small-bowel faeces. • A higher grade of obstruction is commonly associated with phytobezoar impaction. • Mesenteric fatty stranding and intraperitoneal fluid are frequently associated with small-bowel faeces. • Quantitative measurement of the obstructed bowel adds the diagnostic accuracy.
authors.affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Ya-Cheng
authors.initials: YC
authors.lastname: Chen
authors.forename: Chang-Hsien
authors.initials: CH
authors.lastname: Liu
authors.forename: Hsian-He
authors.initials: HH
authors.lastname: Hsu
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Yu
authors.forename: Hong-Hau
authors.initials: HH
authors.lastname: Wang
authors.forename: Hsiu-Lung
authors.initials: HL
authors.lastname: Fan
authors.forename: Ran-Chou
authors.initials: RC
authors.lastname: Chen
authors.forename: Wei-Chou
authors.initials: WC
authors.lastname: Chang
mesh_terms: D001630:Bezoars / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005243:Feces; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D007472:Iohexol