Hernández PJR, Guerrero AG

Language: Spanish
References: 20
Page: 246-253
PDF size: 411.38 Kb.

ABSTRACT

Introduction: blockage of the small intestine is a common clinical entity secondary to difficult intestinal transit at a specific site, due to either mechanical or functional causes. Suspicion of intestinal blockage is based on clinical history, laboratory data, and image studies, among which multisection tomography (MT) plays a key role; it has 90-96% sensitivity, 96% specificity, and 95% certainty. The objective of this study is to show whether the use of MT in this kind of condition at our hospital, is or is not correlated with findings previously reported in the literature on the high sensitivity and specificity of this imaging method and its high precision to show site, cause, degree of blockage, and presence of complications.
Material and methods: a retrospective longitudinal study was performed, within the period from January 2 to July 26, 2012, of patients admitted to the emergency ward with diagnosis of probable intestinal blockage. Only 78 patients in whom intestinal blockage was confirmed by surgical means were included in the study. Sensitivity and specificity of multisection tomography were evaluated.
Results: of the 78 patients included in the study, conducted at Hospital General de Mexico (HGM), intestinal blockage was diagnosed in 69 (88.4%) by means of multisection tomography and confirmed in surgery. This further confirms the findings previously reported in the literature regarding the high sensitivity and specificity of the imaging method in question. In all these patients, level, site, degree of blockage were detected by tomography, and in two of them strangulation. In the remaining 9 patients MT was inconclusive, probably because they had partial blockages in which the imaging method used loses sensitivity.
Discussion: blockage of the small intestine is a frequent entity in hospital emergency services and accounts for at least 20% of total surgeries in patients with acute abdominal pain, primarily those with surgical antecedents that predispose to the formation of flanges and adherences, leading causes of blockage. The clinical manifestations in such patients are abundant in most cases, with abdominal distention, nausea, vomiting, and inability to expel feces and gas, which suggest the diagnosis. However, the surgeon must answer the following questions: Is the blockage mechanical or functional? Where is the blockage located? What is the degree of blockage? Is there intestinal ischemia or strangulation? All these questions can be answered by means of multisection tomography, as has been proven in this study conducted on patients at HGM with diagnosis of intestinal blockage, further ratifying the high sensitivity (88.4%) (69 of 78 patients) and specificity (96%) of this imaging method for this kind of condition. It permits early surgical intervention which expedites the patient’s resumption of activities with minimal aftereffects.
Conclusions: this study has shown that at HGM the use of multisection tomography to diagnose intestinal blockage offers high sensitivity (88.4%) and specificity (96%), and permits early surgical intervention reducing rates of morbidity and mortality. It is considered the method of choice due to its availability, ease of administration, and low cost.

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