Skip to main content
SpringerLink
Log in

Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Purpose: The aim of this study was to investigate the diagnostic performance of contrast-enhanced CT (CECT) findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction (CL-SBO). Materials and Methods: Thirty-five patients with CL-SBO confirmed by laparotomy (n = 34) or multiplanar reconstruction of thin slice CT images (n = 1) were included. Based on the surgical and clinical findings, these patients were classified into three groups: necrosis group (n = 16), ischemia without necrosis group (n = 11), and no-ischemia group (n = 8). Two blinded radiologists retrospectively reviewed CECT including multiplanar reconstruction images and evaluated 12 CT findings. The sensitivity and specificity of each finding were compared among the three groups, and logistic regression analysis was performed. Results: High attenuation of the bowel wall, intraperitoneal air, reduced enhancement of the mesenteric arteries, and small-bowel feces signs showed high specificities of 100%, 100%, 89%, and 89% but low sensitivities of 31%, 25%, 44%, and 31%, respectively, for the prediction of bowel necrosis in CL-SBO. According to multivariate logistic regression analysis, reduced bowel-wall enhancement, reduced enhancement of the mesenteric veins, and a lack of engorgement of the mesenteric veins were significant for predicting bowel ischemia or necrosis (P < 0.05). Conclusions: Reduced enhancements of bowel wall and mesenteric veins were good indicators of bowel ischemia or necrosis. On the contrary, engorgement of the mesenteric veins was a predictor of a viable bowel.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Irvin TT (1989) Abdominal pain: a surgical audit of 1190 emergency admissions. Br J Surg 76:1121–1125

    Article  CAS  PubMed  Google Scholar 

  2. Balthazar EJ (1994) George W. Holmes Lecture. CT of small-bowel obstruction. AJR Am J Roentgenol 162:255–261

    Article  CAS  PubMed  Google Scholar 

  3. Fevang BT, Fevang J, Stangeland L, et al. (2000) Complications and death after surgical treatment of small bowel obstruction: a 35-year institutional experience. Ann Surg 231:529–537

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Frager DH, Baer JW (1995) Role of CT in evaluating patients with small-bowel obstruction. Semin Ultrasound CT MR 16:127–140

    Article  CAS  PubMed  Google Scholar 

  5. Balthazar EJ, Birnbaum BA, Megibow AJ, et al. (1992) Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 185:769–775

    Article  CAS  PubMed  Google Scholar 

  6. Frager D, Baer JW, Medwid SW, Rothpearl A, Bossart P (1996) Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT. AJR Am J Roentgenol 166:67–71

    Article  CAS  PubMed  Google Scholar 

  7. Kato K, Mizunuma K, Sugiyama M, et al. (2010) Interobserver agreement on the diagnosis of bowel ischemia: assessment using dynamic computed tomography of small bowel obstruction. Jpn J Radiol 28:727–732

    Article  PubMed  Google Scholar 

  8. 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

    Article  CAS  PubMed  Google Scholar 

  9. Balthazar EJ, Liebeskind ME, Macari M (1997) Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology 205:519–522

    Article  CAS  PubMed  Google Scholar 

  10. Taourel PG, Fabre JM, Pradel JA, et al. (1995) Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction. AJR Am J Roentgenol 165:1187–1192

    Article  CAS  PubMed  Google Scholar 

  11. Ha HK, Kim JS, Lee MS, et al. (1997) Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria. Radiology 204:507–512

    Article  CAS  PubMed  Google Scholar 

  12. Sheedy SP, Earnest FT, Fletcher JG, Fidler JL, Hoskin TL (2006) CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology 241:729–736

    Article  PubMed  Google Scholar 

  13. Mallo RD, Salem L, Lalani T, Flum DR (2005) Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg 9:690–694

    Article  PubMed  Google Scholar 

  14. Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV (2000) Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR Am J Roentgenol 175:1601–1607

    Article  CAS  PubMed  Google Scholar 

  15. Nicolaou S, Kai B, Ho S, Su J, Ahamed K (2005) Imaging of acute small-bowel obstruction. AJR Am J Roentgenol 185:1036–1044

    Article  PubMed  Google Scholar 

  16. Burkill GJ, Bell JR, Healy JC (2001) The utility of computed tomography in acute small bowel obstruction. Clin Radiol 56:350–359

  17. Furukawa A, Yamasaki M, Furuichi K, et al. (2001) Helical CT in the diagnosis of small bowel obstruction. Radiographics 21:341–355

    Article  CAS  PubMed  Google Scholar 

  18. Jancelewicz T, Vu LT, Shawo AE, et al. (2009) Predicting strangulated small bowel obstruction: an old problem revisited. J Gastrointest Surg 13:93–99

    Article  PubMed  Google Scholar 

  19. Makita O, Ikushima I, Matsumoto N, et al. (1999) CT differentiation between necrotic and nonnecrotic small bowel in closed loop and strangulating obstruction. Abdom Imaging 24:120–124

    Article  CAS  PubMed  Google Scholar 

  20. Idris M, Kashif N, Idris S, et al. (2011) Accuracy of 64-slice multidetector computed tomography scan in detection of the point of transition of small bowel obstruction. Jpn J Radiol 30:235–241

    Article  PubMed  Google Scholar 

  21. Zielinski MD, Eiken PW, Bannon MP, et al. (2010) Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg 34:910–919

    Article  PubMed  Google Scholar 

  22. Boudiaf M, Soyer P, Terem C, et al. (2001) CT evaluation of small bowel obstruction. Radiographics 21:613–624

    Article  CAS  PubMed  Google Scholar 

  23. Silva AC, Pimenta M, Guimaraes LS (2009) Small bowel obstruction: what to look for. Radiographics 29:423–439

    Article  PubMed  Google Scholar 

  24. Assenza M, Ricci G, Macciucca Mde V, et al. (2007) Comparison among preoperative single-slice CT and multi-slice CT in simple, closed loop and strangulating bowel obstruction. Hepatogastroenterology 54:2017–2023

    PubMed  Google Scholar 

  25. Maglinte DD, Howard TJ, Lillemoe KD, Sandrasegaran K, Rex DK (2008) Small-bowel obstruction: state-of-the-art imaging and its role in clinical management. Clin Gastroenterol Hepatol 6:130–139

    Article  PubMed  Google Scholar 

  26. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  27. Megibow AJ, Balthazar EJ, Cho KC, et al. (1991) Bowel obstruction: evaluation with CT. Radiology 180:313–318

    Article  CAS  PubMed  Google Scholar 

  28. Federle MP, Chun G, Jeffrey RB, Rayor R (1984) Computed tomographic findings in bowel infarction. AJR Am J Roentgenol 142:91–95

    Article  CAS  PubMed  Google Scholar 

  29. Mayo-Smith WW, Wittenberg J, Bennett GL, et al. (1995) The CT small bowel faeces sign: description and clinical significance. Clin Radiol 50:765–767

    Article  CAS  PubMed  Google Scholar 

  30. Leffall LD Jr, Quander J, Syphax B (1965) Strangulation intestinal obstruction. Arch Surg 91:592–596

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, National Nagasaki Medical Center, 2-1001-1 Kubara, Omura, 856-8562, Japan

    Kazuaki Nakashima, Toshifumi Fujimoto, Takashi Mizowaki, Kazunori Mitarai, Kei Nakashima & Yohjiro Matsuoka

  2. Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Hideki Ishimaru & Masataka Uetani

Authors
  1. Kazuaki Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hideki Ishimaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshifumi Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Mizowaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazunori Mitarai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kei Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yohjiro Matsuoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masataka Uetani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazuaki Nakashima.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakashima, K., Ishimaru, H., Fujimoto, T. et al. Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction. Abdom Imaging 40, 1097–1103 (2015). https://doi.org/10.1007/s00261-014-0335-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-014-0335-2

Keywords

Search

Navigation