Entrar/Registro  
HOME SPANISH
 
Cirugía y Cirujanos
   
MENU

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board






>Journals >Cirugía y Cirujanos >Year 2014, Issue 6


Quezada-Sanhueza N, León-Ferrufino F, Bächler-González J, Riquelme-Pizarro C, Crovari-Eulufi F, Jarufe-Cassis N
The role of contrast-enhanced computed tomography scan in clinical decision in the management of adhesive small bowel obstruction
Cir Cir 2014; 82 (6)

Language: Español
References: 25
Page: 637-646
PDF: 708.95 Kb.


Full text




ABSTRACT

Background: Computed tomography (CT) is currently the exam of choice for bowel obstruction. The test reports the etiology, site and grade of obstruction, and the presence of bowel ischemia, affecting the surgical decision. We undertook this study to determine the diagnostic accuracy of CT for bowel ischemia and the probability of surgery depending on signs of bowel ischemia and grade of bowel obstruction observed in CT in patients with adhesive small bowel obstruction.
Methods: We carried out a retrospective study including patients from 2007-2010 admitted due to adhesive bowel obstruction and with intravenous contrast-enhanced abdominopelvic CT at admission.
Tomographic signs of bowel ischemia were established and diagnostic accuracy was calculated. We also determined the probability of surgery depending on tomographic grade of obstruction and signs of bowel ischemia by subgroup analysis.
Results: This was a cohort of 164 patients with a mean age of 60.4 ± 20 years; 87% had previous abdominal surgery and 86 patients required surgery (52%). In regard to tomographic signs of bowel ischemia, sensitivity was 72.5%, specificity 97.5%, positive predictive value 90%, negative predictive value 91%, positive likelihood ratio 29.9, and negative likelihood ratio 0.28. Tomographic signs of bowel ischemia simultaneously with high-grade obstruction presented an 83% probability of surgery; high-grade obstruction alone presented a 57% probability and in absence of both signs was 36%.
Conclusions: There is good diagnostic accuracy for tomographic signs of bowel ischemia and its definitive presence. Tomographic signs of bowel ischemia simultaneously with high-grade bowel obstruction significantly increase the probability of surgery.


Key words: Small bowel obstruction, computed tomography, sensitivity, specificity, ischemia, diagnosis.


REFERENCIAS

  1. Miller G, Boman J, Shrier I, Gordon PH. Etiology of small bowel obstruction. Am J Surg 2000;180(1):33-36.

  2. Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A. Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience. Ann Surg 2000;231(4):529-537.

  3. Fevang BT, Jensen D, Svanes K, Viste A. Early operation or conservative management of patients with small bowel obstruction? Eur J Surg 2002;168(8-9):475-481.

  4. Williams SB, Greenspon J, Young HA, Orkin BA. Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum 2005;48(6):1140-1146.

  5. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 1999;353(9163):1476-1480.

  6. Furukawa A, Yamasaki M, Furuichi K, Yokoyama K, Nagata T, Takahashi M, et al. Helical CT in the diagnosis of small bowel obstruction. Radiographics 2001;21(2):341-355.

  7. Delabrousse E, Destrumelle N, Brunelle S, Clair C, Mantion G, Kastler B. CT of small bowel obstruction in adults. Abdom Imaging 2003;28(2):257-266.

  8. Maglinte DD, Heitkamp DE, Howard TJ, Kelvin FM, Lappas JC. Current concepts in imaging of small bowel obstruction. Radiol Clin North Am 2003;41(2):263-283.

  9. Daneshmand S, Hedley CG, Stain SC. The utility and reliability of computed tomography scan in the diagnosis of small bowel obstruction. Am Surg 1999;65(10):922-926.

  10. Rocha FG, Theman TA, Matros E, Ledbetter SM, Zinner MJ, Ferzoco SJ. Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography. Arch Surg 2009;144(11):1000-1004.

  11. Hwang JY, Lee JK, Lee JE, Baek SY. Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion. Eur Radiol 2009;19(10):2425-2431.

  12. Mallo RD, Salem L, Lalani T, Flum DR. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg 2005;9(5):690-694.

  13. Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg 1983;145(1):176-182.

  14. Maglinte DD, Gage SN, Harmon BH, Kelvin FM, Hage JP, Chua GT, et al. Obstruction of the small intestine: accuracy and role of CT in diagnosis. Radiology 1993;188(1):61-64.

  15. Frager D, Baer JW, Medwid SW, Rothpearl A, Bossart P. Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT. AJR Am J Roentgenol 1996;166(1):67-71.

  16. Balthazar EJ, Liebeskind ME, Macari M. Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology 1997;205(2):519-522.

  17. Donckier V, Closset J, Van Gansbeke D, Zalcman M, Sy M, Houben JJ, et al. Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction. Br J Surg 1998;85(8):1071-1074.

  18. Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV. Helical CT Signs in the Diagnosis of Intestinal Ischemia in Small-Bowel Obstruction. AJR Am J Roentgenol 2000;175(6):1601-1607.

  19. Sosa J, Gardner B. Management of patients diagnosed as acute intestinal obstruction secondary to adhesions. Am Surg 1993;59(2):125-128.

  20. Peetz DJ Jr, Gamelli RL, Pilcher DB. Intestinal Intubation in Acute, Mechanical Small-Bowel Obstruction. Arch Surg 1982;117(3):334-336.

  21. Fleshner PR, Siegman MG, Slater GI, Brolin RE, Chandler JC, Aufses AH Jr. A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction. Am J Surg 1995;170(4):366-370.

  22. Dayton MT, Dempsey DT, Larson GM, Posner AR. New paradigms in the treatment of small bowel obstruction. Curr Probl Surg 2012;49(11):642-717.

  23. Fevang BT, Fevang JM, Søreide O, Svanes K, Viste A. Delay in Operative Treatment among Patients with Small Bowel Obstruction. Scand J Surg 2003;92(2):131-137.

  24. Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, et al. Small Bowel Obstruction-Who Needs an Operation? A Multivariate Prediction Model. World J Surg 2010;34(5):910-919.

  25. Schwenter F, Poletti PA, Platon A, Perneger T, Morel P, Gervaz P. Clinicoradiological score for predicting the risk of strangulated small bowel obstruction. Br J Surg 2010;97(7):1119-1125.






>Journals >Cirugía y Cirujanos >Year 2014, Issue 6
 

· Journal Index 
· Links 






       
Copyright 2019