Bowel obstruction CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Abdominal CT scan may be helpful in the diagnosis of bowel obstruction. Findings on CT scan suggestive of bowel obstruction include dilated bowel loops with air-fluid level, distal collapsed bowel, in addition to, "Target", "Whirl" and "Venous cut-off" signs.

CT scan

Abdominal CT scan may be helpful in the diagnosis of bowel obstruction. Findings on CT scan suggestive of bowel obstruction include:^[1]^[2]^[3]^[4]^[5]
- Dilated bowel loops with air-fluid level
- Distal collapsed bowel
  - Additional signs:
    - "Target sign" – indicates intussusception
    - "Whirl sign" – indicates volvulus
    - "Venous cut-off sign" - indicates thrombosis
    - Ascites
    - Edema of the mesentery and submucosal edema
    - Hemorrhage
    - Bowel wall thickness exceeding 3mm

A non-straight border indicates a small bowel obstruction on CT by James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15997133

Advantages over X-ray

CT scan can determine the following over plain X-ray:
- Specific site of obstruction
- Severity of obstruction
  - Complete or partial
- Etiology
  - Such as a hernia or mass or inflammations
- Complications
  - Such as ischemia, necrosis, and perforations

Timing of CT scan

It is recommended to perform an X-ray first, especially if intervention is needed immediately, since X-rays are readily available, afford less radiation to the patient and are more cost effective.
However, CT scan is more effective at determining those cases that need surgical intervention and can provide more surgical detail.

Sensitivity and specificity of CT scanning according to slice margin

Slice thickness (mm)	Sensitivity	Specificity
50	79	87
5 -10	87	81
0.75	96	100

The comparison table for diagnostic studies of choice for bowel obstruction^[5]

	Sensitivity	Specificity
CT	93%	100%
X-ray	50%	75%

References

↑ Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J (2011). "Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery". World J Emerg Surg. 6: 5. doi:10.1186/1749-7922-6-5. PMC 3037327. PMID 21255429.
↑ Mullan CP, Siewert B, Eisenberg RL (2012). "Small bowel obstruction". AJR Am J Roentgenol. 198 (2): W105–17. doi:10.2214/AJR.10.4998. PMID 22268199.
↑ Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I (2007). "Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome". World J. Gastroenterol. 13 (3): 432–7. PMC 4065900. PMID 17230614.
↑ Balthazar EJ (1994). "George W. Holmes Lecture. CT of small-bowel obstruction". AJR Am J Roentgenol. 162 (2): 255–61. doi:10.2214/ajr.162.2.8310906. PMID 8310906.
↑ ^5.0 ^5.1 Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD (1999). "Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction". Acta Radiol. 40 (4): 422–8. PMID 10394872.

Template:WikiDoc Sources

[pmid21255429-1] Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J (2011). "Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery". World J Emerg Surg. 6: 5. doi:10.1186/1749-7922-6-5. PMC 3037327. PMID 21255429.

[pmid22268199-2] Mullan CP, Siewert B, Eisenberg RL (2012). "Small bowel obstruction". AJR Am J Roentgenol. 198 (2): W105–17. doi:10.2214/AJR.10.4998. PMID 22268199.

[pmid17230614-3] Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I (2007). "Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome". World J. Gastroenterol. 13 (3): 432–7. PMC 4065900. PMID 17230614.

[pmid8310906-4] Balthazar EJ (1994). "George W. Holmes Lecture. CT of small-bowel obstruction". AJR Am J Roentgenol. 162 (2): 255–61. doi:10.2214/ajr.162.2.8310906. PMID 8310906.

[pmid10394872-5] 5.0 ^5.1 Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD (1999). "Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction". Acta Radiol. 40 (4): 422–8. PMID 10394872.

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