Abstract
The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemar's test was used to detect any statistical difference in POT evaluation between datasets A and B. Kappa statistics were applied for measuring agreement between two readers. Results. There was a diagnostic improvement of 9.9% in the case of the less experienced radiologist in localizing POT by using oblique reformatted images. The more experienced radiologist showed diagnostic improvement by 12.9%.
Highlights
Small bowel obstruction (SBO) is a common clinical condition as a cause of abdominal pain, accounting for approximately 20% of all emergency admissions for acute abdomen
Plain X-ray abdominal evaluation still remains the investigation of first choice in cases of suspected SBO due to its low cost and wide availability, it cannot reliably diagnose the exact level of obstruction and can only serve as a basis for triage for further imaging workup [5, 6]
The commonest cause of SBO in the study group was adhesions found on laparotomy (n = 59), followed by hernias (n = 17) and small bowel obstruction secondary to tuberculosis (n = 16)
Summary
Small bowel obstruction (SBO) is a common clinical condition as a cause of abdominal pain, accounting for approximately 20% of all emergency admissions for acute abdomen. It is amongst one of the commonest bowel pathologies leading to surgical consultation [1,2,3]. The paradigm was to “never let the sun set or rise on an obstructed bowel.”. This probably was an evidence of limitations regarding availability of various imaging modalities for diagnosing the exact site of SBO [4]. Plain X-ray abdominal evaluation still remains the investigation of first choice in cases of suspected SBO due to its low cost and wide availability, it cannot reliably diagnose the exact level of obstruction and can only serve as a basis for triage for further imaging workup [5, 6]
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