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Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

  • Gastrointestinal
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Abstract

Objective

The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO).

Methods

We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air–fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared.

Results

A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, −59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < −11.75 HU predicted phytobezoar impaction.

Conclusions

MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces.

Key Points

• MDCT examination helps to differentiate phytobezoar and small-bowel faeces.

• A higher grade of obstruction is commonly associated with phytobezoar impaction.

• Mesenteric fatty stranding and intraperitoneal fluid are frequently associated with small-bowel faeces.

• Quantitative measurement of the obstructed bowel adds the diagnostic accuracy.

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Abbreviations

SBO:

Small-bowel obstruction

MDCT:

Multi-detector computed tomography

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Acknowledgments

We would like to give special thanks to Benjamin Yen, M.D., professor at the University of California, San Francisco, for his guidance and help. We thank the Research Office for Health Data, Department of Education and Research, Taipei City Hospital, Taiwan for their valuable contributions in data management and statistical analysis.

The scientific guarantor of this publication is Wei-Chou, Chang. This study has received funding by Tri-Service General Hospital Research Grant (TSGH-C100-044). The Research Office for Health Data, Department of Education and Research, Taipei City Hospital, Taiwan kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. (TSGHIRB-1-101-05-091). Written informed consent was not required for this study because our study is a retrospective study for imaging differentiation, and does no harm to human bodies. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, was performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Ya-Cheng Chen, Chang-Hsien Liu, Hsian-He Hsu, Chih-Yung Yu, Hong-Hau Wang & Wei-Chou Chang

  2. Department of Radiology, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Hong-Hau Wang

  3. Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Hsiu-Lung Fan

  4. Department of Radiology, Taipei City Hospital, Taipei, Taiwan, Republic of China

    Ran-Chou Chen

  5. Department of Biochemical Imaging and Radiological Sciences, National Yang-Ming Univeristy, Taipei, Taiwan, Republic of China

    Ran-Chou Chen & Wei-Chou Chang

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  1. Ya-Cheng Chen
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  2. Chang-Hsien Liu
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Correspondence to Wei-Chou Chang.

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Chen, YC., Liu, CH., Hsu, HH. et al. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction. Eur Radiol 25, 922–931 (2015). https://doi.org/10.1007/s00330-014-3486-1

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  • DOI: https://doi.org/10.1007/s00330-014-3486-1

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