title: Sensitivity and Specificity of CT and Its signs for Diagnosis of Strangulation in Patients with Acute Small Bowel Obstruction.
abstract: BACKGROUND
  To perform a meta-analysis to review the sensitivity and specificity of computed tomography and different known computed yomography signs for the diagnosis of strangulation in patients with acute small bowel obstruction.
  
  
  METHODS
  A comprehensive Pubmed search was performed for all reports that evaluated the use of CT and discussed different CT criteria for the diagnosis of acute SBO. Articles published in English language from January 1978 to June 2008 were included. Review articles, case reports, pictorial essays and articles without original data were excluded. The bivariate random effect model was used to obtain pooled sensitivity and pooled specificity. Summary receiver operating curve was calculated using Meta-Disc. Software Openbugs 3.0.3 was used to summarize the data.
  
  
  RESULTS
  A total of 12 studies fulfilled the inclusion criteria. The pooled sensitivity and specificity of CT in the diagnosis of strangulation was 0.720 (95% CI 0.674 to 0.763) and 0.866 (95% CI 0.837 to 0.892) respectively. Among different CT signs, mesenteric edema had highest Pooled sensitivity of 0. 741 and lack of bowel wall enhancement had highest pooled specificity of 0.991.
  
  
  CONCLUSIONS
  This review demonstrates that CT is highly sensitive as well as specific in the preoperative diagnosis of strangulation SBO which are in accordance with the published studies. Our analysis also shows that "presence of mesenteric fluid" is most sensitive, and "lack of bowel wall enhancement" is most specific CT sign of strangulation, and also justifies need of large scale prospective studies to validate the results obtained as well as to determine a clinical protocol.
authors.affiliation: Department of General Surgery, JMCTH, Janakpurdham, Dhanusha, Nepal.
authors.forename: Ashwini Kumar
authors.initials: AK
authors.lastname: Jha
authors.affiliation: Department of General Surgery, ZhongDa Hospital Affiliated To SouthEast University, Nanjing, China.
authors.forename: Wen Hao
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Department of General Surgery, ZhongDa Hospital Affiliated To SouthEast University, Nanjing, China.
authors.forename: Zhi Bin
authors.initials: ZB
authors.lastname: Bai
authors.affiliation: Department of General Surgery, ZhongDa Hospital Affiliated To SouthEast University, Nanjing, China.
authors.forename: Jia Quan
authors.initials: JQ
authors.lastname: Xiao
mesh_terms: D000208:Acute Disease; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D007415:Intestinal Obstruction / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: Acute small bowel obstruction; bowel Ischemia; Computed Tomography; strangulation.