Occlusions du grêle sur bride : le scanner spirale surestime la gravité des lésions

Abstract

Introduction: The aim of this study was to evaluate prospectively the impact of the routine use of abdominal spiral computed tomography (SCT) in patients with postoperative small bowel obstruction (SBO) for whom initial conservative treatment was proposed. Patient et methods: We have compared the management of SBO in patients with clinical stable condition in two successive periods : from 1989 to 1998, 127 patients (preSCT group) for whom management was based on standard clinical-biological-radiological assessment (CBRA) et from 1999 to 2000, 30 patients (SCT group) for whom management included SCT. The decision of surgical team was correlated with the type of small bowel obstruction at laparotomy : closed-loop obstruction without intestinal necrosis (true-positive), intestinal necrosis as a consequence of delayed diagnosis defined as false-negative, diffuse adhesion defined as false-positive et patient non operated defined as true-negative. Results: Among the 127 patients from the preSCT group, 87 were treated conservatively and 40 were operated : SBO with closed-loop obstruction without intestinal necrosis ( n = 29,72%), SBO with diffuse adhesion ( n = 4, 10%) and SBO with intestinal necrosis ( n = 7, 17%). Among the 30 patients from the SCT group, 16 were treated conservatively and 14 were operated: SBO with closed-loop obstruction without intestinal necrosis ( n = 8, 57%), SBO with diffuse adhesion ( n = 6,43%) and SBO with intestinal necrosis ( n = 0,0% ; NS). Both groups were similar for rates of patients with SBO with or without necrosis and rate of patients treated conservatively (NS). In SCT group, there was significantly more patients opereated for diffuse adhesions ( p < 0,01). Negative predictive value of CBRA + TDM was significantly higher than those of CBRA alone ( p = 0,041). Conclusion: Due to a very high sensibility, TDM increase probably the rate of early laparotomies, maybe unnecessary, in patients without any sign of SBO due to closed-loop obstruction. Thus, systematic use of TDM in patients with clinical suspicion of SBO remains to be evaluated.