VALUE OF CT IN THE DIAGNOSIS AND MANAGEMENT OF PATIENTS WITH SUSPECTED ACUTE SMALL-BOWEL OBSTRUCTION

OBJECTIVE. The purpose of this prospective study was to evaluate the r ole of CT in the diagnosis of patients with suspected acute small-bowe l obstruction in whom clinical and plain radiographic findings were in conclusive. SUBJECTS AND METHODS. Fifty-seven nonconsecutive patients with suspected acute small bowel obstruction were referred for CT to d ifferentiate small-bowel obstruction from ileus (33 patients) or to es tablish the cause of obstruction (24 patients). The final diagnosis wa s established either by surgery (42 patients) or by the clinical evolu tion (15 patients). The change in the prescan diagnosis as to the pres ence, cause, and severity (strangulation) of small-bowel obstruction m ade on the basis of the CT findings was noted. Finally, the changes in therapy resulting from the CT information were recorded. RESULTS. CT correctly distinguished between small-bower obstruction and ileus in a ll cases except one. CT enabled us to modify an erroneous clinical dia gnosis correctly in 12 (21%) of 57 cases, including eight cases for wh ich pre-CT diagnosis was ileus and four cases for which pre-CT diagnos is was small-bowel obstruction. CT allowed us to predict the cause of obstruction correctly in 33 (85%) of 39 patients with confirmed small- bowel obstruction but it failed to differentiate adhesions from intern al hernias and radiation enteritis. The pre-CT diagnosis of the cause of obstruction was correctly changed because of CT findings in 17 (44% ) of 39 patients with subsequently proved small-bowel obstruction. CT was able to identify strangulation in nine of the 12 patients with pro ved strangulation, which altered the pre-CT diagnosis in three patient s. CT findings correctly modified the management in 12(21%)of 57 patie nts, by changing either a conservative management to an operative one in 10 (18%), or an operative to a conservative one by differentiating ileus from obstruction in two patients. CONCLUSION. Our findings show that CT is a valuable diagnostic procedure in patients with suspected acute small-bowel obstruction. CT not only is useful in distinguishing obstruction from paralytic ileus, but it frequently establishes the c ause of the obstruction and the presence of strangulation. CT findings lead to decisions to treat patients surgically in a significant numbe r of patients.