>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)
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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.
||Small bowel obstruction, computed tomography, sensitivity, specificity, ischemia, diagnosis.
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>Cirugía y Cirujanos
>Year 2014, Issue 6