RELIABILITY AND ROLE OF PLAIN FILM RADIOGRAPHY AND CT IN THE DIAGNOSIS OF SMALL-BOWEL OBSTRUCTION

OBJECTIVE. We compare the reliability and define the role of plain fil m radiography and CT in the assessment of various severities of small- bowel obstruction. MATERIALS AND METHODS, A blinded retrospective anal ysis was done on 78 patients who underwent plain abdominal radiography , CT, and enteroclysis to assess for suspected small-bowel obstruction . The findings at enteroclysis and the clinical outcomes were used as standards of reference. RESULTS. The sensitivity of plain film radiogr aphy for revealing small-bowel obstruction was 69% (44/64), and its sp ecificity was 57% (8/14). Overall accuracy of plain film radiography w as 67% (52/78). The sensitivity and specificity of CT were 64% (41/64) and 79% (11/14), respectively. Overall accuracy of CT was 67% (52/78) . When obstructions were classified as low- and high-grade partial obs truction, plain film radiography and CT had sensitivities of 86% (24/2 8) and 82% (23/28), respectively, for high-grade obstruction and 56% ( 20/36) and 50% (18/36), respectively, for low-grade obstruction. CT re vealed the cause of the small-bowel obstruction in 95% (39/41) of thos e patients in whom CT correctly showed the obstruction. CONCLUSION. Pl ain film radiography and CT had similar overall accuracies in showing small-bowel obstruction of various severities. Plain film radiography should remain the initial method of imaging patients with suspected sm all-bowel obstruction. The ability of CT to show the cause of small-bo wer obstruction makes CT an important additional diagnostic tool when specific management issues must be addressed.