INTESTINAL ISCHEMIA IN PATIENTS IN WHOM SMALL-BOWEL OBSTRUCTION IS SUSPECTED - EVALUATION OF ACCURACY, LIMITATIONS, AND CLINICAL IMPLICATIONS OF CT IN DIAGNOSIS

PURPOSE: To determine the accuracy of computed tomography (CT) in diag nosis of intestinal ischemia in patients with possible intestinal obst ruction and the limitations and clinical implications of use of CT. MA TERIALS AND METHODS: In 100 patients in whom intestinal obstruction wa s suspected clinically, CT findings were correlated with surgical find ings in 77 patients and with follow-up clinical findings after nasogas tric suction in 23 patients. The interval between CT and surgical expl oration in patients with ischemic bowel was 1-98 hours (mean, 13 hours ). RESULTS: Correlation of CT findings of strangulation obstruction wi th surgical findings revealed 72 true-negative, 19 true-positive, five false-positive, and four false-negative CT results. Sensitivity was 8 3%, specificity was 93%, accuracy was 91%, positive predictive value w as 79%, and negative predictive value was 95%. CONCLUSION: CT enables accurate detection of bowel ischemia, particularly when small bowel ob struction is present. Exploratory laparotomy should be performed when unexplained disparities exist between equivocal CT findings and a dete riorating clinical condition in patients with possible small bowel obs truction or mesenteric infarction.