Abstract
Identification of adhesions on computed tomography (CT) in cases of small-bowel obstruction (SBO) is currently a diagnosis of exclusion. The purpose of this study is to examine whether the presence of findings suggestive of an extraluminal band can be used as a CT sign for adhesive SBO. CT scans of 142 patients with surgically proven SBO performed within 72 h of exploratory surgery were reviewed. The studies were evaluated for the cause of SBO and the presence of extraluminal bands. An extraluminal band was considered present if there was a change in the conformation of the transition zone, suggesting extraluminal compression of the bowel by a linear obstructive band. The presence of extraluminal bands in the area of the transition zone had a high positive predictive value for adhesive SBO. Of the 73 cases in which bands were present, SBO was due to adhesions in 52 instances, with a corresponding positive predictive value of 71% (95% confidence interval 0.60–0.80) and a p value of 0.008. The extraluminal band was 61% sensitive and 63% specific for adhesive SBO. The presence of an extraluminal band on CT in the area of the transition zone in cases of SBO correlates well with a diagnosis of SBO secondary to adhesions. In the absence of a source of SBO, the presence of an extraluminal band can serve as a helpful diagnostic adjunct for adhesive SBO.
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References
Suh RS, Maglinte DDT, Lavonas EJ et al (1995) Emergency abdominal radiography: discrepancies of preliminary and final interpretation and management relevance. Emerg Radiol 2:1–4
McFadden DW, Zinner MJ (1994) Manifestations of gastrointestinal disease. In: Schwartz SI, Shires GT, Spencer FC (eds) Principles of surgery. McGraw-Hill, New York, pp 1015–1042
Megibow AJ, Balthazar EJ, Cho KC et al (1991) Bowel obstruction: evaluation with CT. Radiology 180:313–318
Fukuya T, Hawes DR, Lu CC et al (1992) CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol 158:765–769
Furukawa A, Yamasaki M, Furuichi K et al (2001) Helical CT in the diagnosis of small bowel obstruction. Radiographics 21:341–355
Maglinte DT, Reyes BL, Harmon BH et al (1996) Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol 167:1451–1455
Frager DH, Baer JW (1995) Role of CT in evaluating patients with small-bowel obstruction. Semin Ultrasound CT MR 16:127–140
Hulnick DH (1986) Small intestine. In: Balthazar EJ, Megibow AJ (eds) Computed tomography of the gastrointestinal tract. Mosby, St. Louis, p 273
Balthazar EJ (1994) George W. Holms Lecture. CT of small-bowel obstruction. AJR Am J Roentgenol 162:255–261
Bizer LS, Liebling RW, Delany HM et al (1981) Small bowel obstruction: the role of non-operative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. Surgery 89:407–413
Livingstone AS, Sosa JL (1995) Ileus and obstruction. In: Haubrich WS, Schauffnewer F, Berk JE (eds) Bockus gastroenterology, 5th edn. Saunders, Philadelphia, pp 1235–1248
Herlinger H, Maglinte DDT (1989) Small bowel obstruction. In: Herlinger H, Maglinte DDT (eds) Clinical radiology of the small intestine. Saunders, Philadelphia pp 479–507
Moses BV (2000) Surgical conditions of the small intestine. In: Ratnaike, R (ed) Small bowel disorders. Arnold, London, pp 472–481
Donckier V, Closset J, Van Gansbeke D et al (1998) Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction. Br J Surg 85:1071–1074
Caoili EM, Paulson EK (2000) CT of small bowel obstruction: another perspective using multi-planar reformations. AJR Am J Roentgenol 174:993–998
Boudiaf M, Soyer P, Terem C et al (2001) CT evaluation of small bowel obstruction. Radiographics 21:613–624
Maglinte DT, Gage SN, Harmon BH et al (1993) Obstruction of the small intestine: accuracy and role of CT in diagnosis. Radiology 188:61–64
Herlinger H (1997) Radiology evaluation of small bowel obstruction. RSNA categorical course in diagnostic radiology. Gastrointestinal 49–58
Ha HK, Park CH, Kim SK et al (1993) CT analysis of intestinal obstruction due to adhesions: early detection of strangulation. J Comput Assist Tomogr 17:386–389
Welch JP (1990) Adhesions. In: Welch JP (ed) Bowel obstruction: differential diagnosis and clinical management. Saunders, Philadelphia, pp 154–165
Suter M, Zermatten P, Halkic N et al (2000) Laparoscopic management of mechanical small bowel obstruction. Surg Endosc 14:478–483
Menzies D, Ellis H (1989) Intra-abdominal adhesions and their prevention by topical tissue plasminogen activator. J R Soc Med 82:534–535
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Petrovic, B., Nikolaidis, P., Hammond, N.A. et al. Identification of adhesions on CT in small-bowel obstruction. Emerg Radiol 12, 88–93 (2006). https://doi.org/10.1007/s10140-005-0450-z
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DOI: https://doi.org/10.1007/s10140-005-0450-z