BACKGROUND: Small-bowel obstruction (SBO) is a common dilemma faced by general surgeons. A timely and accurate diagnosis is crucial, based on history, physical examination, and radiographic studies. A computed tomography (CT) scan has become an increasingly common diagnostic modality. The aim of this study was to define a set of CT criteria that may help determine whether a patient would require operative intervention. METHODS: A retrospective chart review was performed over an 18-month period. Patients diagnosed with SBO or partial SBO (PSBO) who had a CT scan performed were included. CT scans were then reviewed independently by a staff radiologist blinded to the clinical outcome. A scoring system based on 7 radiographic criteria was then developed. Statistical analysis was performed on the data. RESULTS: From March 1, 2004, to August 30, 2005, 96 patients were found to have the diagnosis of SBO or PSBO and a documented CT scan. Seventy-four patients had undergone prior intra-abdominal procedures. Fifty-five percent were taken to the operating room (OR) over an average of 1.9 days (range 1-12 days). Seventy-nine percent of these patients went to the OR within the first 24 hours. Lysis of adhesions was performed in 38%, small bowel was resected in 47%, and incarcerated ventral hernias were found in 11%. Ischemic bowel was found in 11% of the cases. The CT scoring system was then correlated with the actual treatment. A score of 8 or higher predicted the need for surgery 75% of the time. When looking at the criteria individually, patients with a CT reading of complete obstruction, dilated small bowel, or free fluid were operated on 77%, 66%, and 65% of the time, respectively. CONCLUSION: A CT scoring system can successfully predict the need for surgery 75% of the time. Likewise, specific criteria, when present in combination, can predict the need for operative intervention in 79% of cases with SBO.
BACKGROUND:Small-bowel obstruction (SBO) is a common dilemma faced by general surgeons. A timely and accurate diagnosis is crucial, based on history, physical examination, and radiographic studies. A computed tomography (CT) scan has become an increasingly common diagnostic modality. The aim of this study was to define a set of CT criteria that may help determine whether a patient would require operative intervention. METHODS: A retrospective chart review was performed over an 18-month period. Patients diagnosed with SBO or partial SBO (PSBO) who had a CT scan performed were included. CT scans were then reviewed independently by a staff radiologist blinded to the clinical outcome. A scoring system based on 7 radiographic criteria was then developed. Statistical analysis was performed on the data. RESULTS: From March 1, 2004, to August 30, 2005, 96 patients were found to have the diagnosis of SBO or PSBO and a documented CT scan. Seventy-four patients had undergone prior intra-abdominal procedures. Fifty-five percent were taken to the operating room (OR) over an average of 1.9 days (range 1-12 days). Seventy-nine percent of these patients went to the OR within the first 24 hours. Lysis of adhesions was performed in 38%, small bowel was resected in 47%, and incarcerated ventral hernias were found in 11%. Ischemic bowel was found in 11% of the cases. The CT scoring system was then correlated with the actual treatment. A score of 8 or higher predicted the need for surgery 75% of the time. When looking at the criteria individually, patients with a CT reading of complete obstruction, dilated small bowel, or free fluid were operated on 77%, 66%, and 65% of the time, respectively. CONCLUSION: A CT scoring system can successfully predict the need for surgery 75% of the time. Likewise, specific criteria, when present in combination, can predict the need for operative intervention in 79% of cases with SBO.
Authors: Swati D Deshmukh; David S Shin; Juergen K Willmann; Jarrett Rosenberg; Lewis Shin; R Brooke Jeffrey Journal: Eur Radiol Date: 2010-10-21 Impact factor: 5.315
Authors: Martin D Zielinski; Patrick W Eiken; Michael P Bannon; Stephanie F Heller; Christine M Lohse; Marianne Huebner; Michael G Sarr Journal: World J Surg Date: 2010-05 Impact factor: 3.352
Authors: Lucas W Thornblade; Francys C Verdial; Matthew A Bartek; David R Flum; Giana H Davidson Journal: J Gastrointest Surg Date: 2019-02-20 Impact factor: 3.452
Authors: Matthew C Hernandez; Arianna Birindelli; John L Bruce; Johannes J P Buitendag; Victory Y Kong; Mircea Beuran; Johnathon M Aho; Ionut Negoi; Damian L Clarke; Salomone Di Saverio; Martin D Zielinski Journal: World J Surg Date: 2018-11 Impact factor: 3.352