Atsushi Kohga1, Akihiro Kawabe2, Kiyoshige Yajima2, Takuya Okumura2, Kimihiro Yamashita2, Jun Isogaki2, Kenji Suzuki2, Katsuaki Muramatsu3. 1. Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan. akohga11@yahoo.co.jp. 2. Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan. 3. Division of Radiology, Fujinomiya City General Hospital, Fujinomiya, Shizuoka, 4180076, Japan.
Abstract
PURPOSE: To determine the differential points of strangulated ileus with and without irreversible ischaemic changes, especially on preoperative computed tomography (CT) images. METHODS: Seventy patients with strangulated ileus underwent emergency operations between January 2009 and July 2016 in our department. Of these patients, 57 met the study requirements, including 30 patients who had irreversible ischaemic changes (ischaemic group; n = 30) and 27 patients who had reversible ischaemic changes during laparotomy (non-ischaemic group; n = 27). We compared the preoperative clinical and radiographic factors between the ischaemic and non-ischaemic groups. RESULTS: Univariate analysis revealed that a mean CT value of the intestine in an unenhanced image ≥16.5 HU (p < 0.001), a mean CT value ratio of the intestine (enhanced/unenhanced image) <1.5 (p < 0.001), presence of mesenteric fluid (p = 0.002) and presence of free peritoneal fluid (p = 0.009) were associated with the ischaemic group. CONCLUSIONS: Calculation of the mean CT value of a strangulated intestine may be a useful method for predicting irreversible ischaemic changes in addition to the presence of mesenteric fluid or free peritoneal fluid.
PURPOSE: To determine the differential points of strangulated ileus with and without irreversible ischaemic changes, especially on preoperative computed tomography (CT) images. METHODS: Seventy patients with strangulated ileus underwent emergency operations between January 2009 and July 2016 in our department. Of these patients, 57 met the study requirements, including 30 patients who had irreversible ischaemic changes (ischaemic group; n = 30) and 27 patients who had reversible ischaemic changes during laparotomy (non-ischaemic group; n = 27). We compared the preoperative clinical and radiographic factors between the ischaemic and non-ischaemic groups. RESULTS: Univariate analysis revealed that a mean CT value of the intestine in an unenhanced image ≥16.5 HU (p < 0.001), a mean CT value ratio of the intestine (enhanced/unenhanced image) <1.5 (p < 0.001), presence of mesenteric fluid (p = 0.002) and presence of free peritoneal fluid (p = 0.009) were associated with the ischaemic group. CONCLUSIONS: Calculation of the mean CT value of a strangulated intestine may be a useful method for predicting irreversible ischaemic changes in addition to the presence of mesenteric fluid or free peritoneal fluid.
Authors: Masja K Toneman; Bente M de Kok; Frank M Zijta; Stanley Oei; Gijs J D van Acker; Marinke Westerterp; Anne E M van der Pool Journal: World J Gastrointest Surg Date: 2022-06-27