Intravenous Contrast Agent in Abdominal CT: Is It Really Needed to Identify the Cause of Bowel Obstruction? Proof of Concept.

Federica Vernuccio,Roberto Lagalla,Giuseppe Salvaggio,Dario Picone,Massimo Midiri,Gregorio Scerrino,Giuseppe Lo Re

doi:10.1155/2019/2350948

Abstract

Background To compare sensitivity of unenhanced computed tomography (CT) and contrast-enhanced CT for the identification of the etiology of bowel obstruction. Materials and Methods We retrospectively evaluated abdominal CT scans of patients operated for bowel obstruction from March 2013 to October 2017. Two radiologists evaluated CT scans before and after contrast agent in two reading sessions. Then, we calculated sensitivity of CT in the diagnosis of bowel obstruction and determined in which cases the etiology of bowel obstruction was detected on both unenhanced and enhanced CT or on enhanced CT only. The reference standard was defined as the final diagnosis obtained after surgery. Results Eighteen patients (mean age 72 ± 15 years, age range 37-88 years) were included in the study. Sensitivity of unenhanced CT and enhanced CT was not significantly different in either small bowel obstruction (64%, 7/11 patients vs. 73%, 8/11 patients; P = 0.6547) or large bowel obstruction (71%, 5/7 patients vs. 100%, 7/7 patients; P = 0.1410). Adhesions were identified on unenhanced CT as the etiology of small bowel obstruction in 80% (4/5) of patients. Tumors were identified on unenhanced CT as the etiology of large bowel obstruction in 67% (4/6) of patients. Conclusion In the diagnosis of small bowel obstruction due to adhesions with normal bowel wall thickening and when a neoplasm is identified as the etiology of large bowel obstruction on unenhanced CT, an intravenous contrast agent may be avoided for the identification of the etiology. In remaining cases, contrast agent is still recommended.

Highlights

Bowel obstruction may be the result of a mechanical obstacle or a failure of the bowel to move properly
In the diagnosis of small bowel obstruction due to adhesions with normal bowel wall thickening and when a neoplasm is identified as the etiology of large bowel obstruction on unenhanced computed tomography (CT), an intravenous contrast agent may be avoided for the identification of the etiology
In 3 patients with small bowel obstruction, etiology was missed at both unenhanced and enhanced CT including one patient with volvulus, one with adhesions related to chronic appendicitis and ileal tumor, and one patient with infiltrating retroperitoneal neoplasm that was misdiagnosed on CT as a duodenal tumor

Summary

Introduction

Bowel obstruction may be the result of a mechanical obstacle or a failure of the bowel to move properly (i.e., paralytic ileus). Large bowel obstruction 7 patients (mean age: 77 years; 2 M, 5 F). Small bowel obstruction 11 patient (mean age: 69 years, 5 M, 6 F). To compare sensitivity of unenhanced computed tomography (CT) and contrast-enhanced CT for the identification of the etiology of bowel obstruction. Adhesions were identified on unenhanced CT as the etiology of small bowel obstruction in 80% (4/5) of patients. Tumors were identified on unenhanced CT as the etiology of large bowel obstruction in 67% (4/6) of patients. In the diagnosis of small bowel obstruction due to adhesions with normal bowel wall thickening and when a neoplasm is identified as the etiology of large bowel obstruction on unenhanced CT, an intravenous contrast agent may be avoided for the identification of the etiology.

Objectives

Methods

Results

Conclusion