Aims and objectives
Bowel strangulation iswell-known bowel pathology which is one of the causes of bowel obstruction and ischemia. The patients with this disease may come to the hospital with various nonspecific symptoms including abdominal pain,
nausea,
vomiting,
and abdominal fullness,
and it is not easy to diagnose and manage these patients adequately without any delay. Previous papers mentioned about the various Computed Tomography (CT) findings of bowel strangulation but there is no paper whichdiscusses about significance ofdiagnosing the stage of bowel strangulation which can predict bowel prognosis...
Methods and materials
We retrospectively reviewed 49 patients with bowel strangulation proved by surgical operation (April,
2007-October,
2014). We estimated clinical,
CT,
andsurgical findings and compared those between stages,
which werediagnosed according to CT findings.
1) Evaluated factors include;
• Time from onset to CT scan (Onset-to-scan time: OST)
• Time from CT scan to operation(Scan-to-operation time: SOT)
• Time from onset to operation time (Onset-to-operation time: OOT)
• Clinical symptoms
• Presence of peritoneal irritation
• LDH(Lactate dehydrogenase)
• CPK(Creatine phosphokinase)
• CT findings
• Bowel resection...
Results
The results are summarized on the table 2,
3,
4,
and 5.
Table 2 shows differences in clinico-radio-surgical findings between stages.
Table 3 shows differences between bowel resection group and non-resection group regardless of stages.
Table 4 and 5 show differences between resection group and non-resection group on the stage II and III.
Bowel resection ratewas getting higher as stage advanced.There were no statistically significant differences on the values of CPK and LDH and the presence rates of peritoneal irritation on stage II,
III and,...
Conclusion
It is difficult to estimate prognosis of closed bowel loop with clinical findings because they are nonspecific. The novel CTstaging system for bowel stragngulation is useful to estimate severity andurgency of this disease processfor adequate management in time with briefest delay.
Personal information
Fumie Sato,
M.D.
Division of Emergency and Trauma Radiology
Department of Emergency and Critical Care Medicine
St.
Marianna University School of Medicine
2-16-1 Sugao,
Miyamae-ku,
Kawasaki,
Kanagawa 216-8511,
Japan
E-mail:
[email protected]
References
1) Hayakawa K,
Tanikake M,
Yoshida S,
Yamamoto A,
Yamamoto E,
Morimoto T.
CT findings of small bowel strangulation: the importance of contrast enhancement.
Emerg Radiol.
2013 Jan;20(1):3-9.
2) Zielinski MD,
Eiken PW,
Heller SF,
Lohse CM,
Huebner M,
Sarr MG,
Bannon MP.
Prospective,
observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention.
J Am Coll Surg.
2011 Jun;212(6):1068-76.
3) Wiesner W,
Mortele K.
Small bowel ischemia caused by strangulation in complicated small bowel obstruction.
CT findings in 20...