D. Frager et al., DETECTION OF INTESTINAL ISCHEMIA IN PATIENTS WITH ACUTE SMALL-BOWEL OBSTRUCTION DUE TO ADHESIONS OR HERNIA - EFFICACY OF CT, American journal of roentgenology, 166(1), 1996, pp. 67-71
OBJECTIVE. The purpose of this study was to determine whether CT can b
e used to diagnose ischemia of the small intestine in patients with sm
all-bowel obstruction due to adhesions or hernia, SUBJECTS AND METHODS
. During a 12-month period, 60 patients underwent surgery for complete
or high-grade small-bowel obstruction due to adhesions or hernia, and
29 (48%) had evidence of associated intestinal ischemia. All of these
patients had been preoperatively diagnosed by CT as having high-grade
small-bower obstruction, At the same time, a prospective determinatio
n was made based on the CT studies as to whether there was any associa
ted intestinal ischemia, All CT scans were performed within 24 hours o
f the operation. A CT diagnosis of ischemia was based on the presence
of two or more of the following signs: bower-wall thickening, high att
enuation of the bowel wall on unenhanced CT scans, mesenteric edema or
fluid, asymmetric bowel-wall enhancement on IV contrast-enhanced CT s
cans, pneumatosis, or portal venous gas, Results of the CT examination
and surgical findings were then compared, Further evaluation was done
with a retrospective multivariate discriminant analysis, RESULTS, Isc
hemia was prospectively diagnosed on the basis of CT findings in 41 (6
8%) of the 60 patients, There were no false-negative CT diagnoses (sen
sitivity, 100%); however, there were 12 CT diagnoses that were false-p
ositive (specificity, 61%),The multivariate analysis corroborated the
prospective results by showing high sensitivity (90%) and diminished s
pecificity (50-64%), Bowel wall thickening and high attenuation of the
bowel wall were the most important signs of ischemia on unenhanced CT
scans, whereas abnormal bowel-wall enhancement and mesenteric fluid c
orrelated best on enhanced CT examinations. CONCLUSION, CT is a sensit
ive but not completely specific preoperative indicator of intestinal i
schemia in patients with small-bower obstruction due to hernias or adh
esions.