Role of multislice computed tomography in evaluation and management of intestinal obstruction.

Durgesh Kumar Saini,Chikkala Kanak Durga,Kiran Saini,Poras Chaudhary

doi:10.4081/cp.2013.e20

Abstract

The aims and objectives of this study were: i) to evaluate the efficacy of computed tomography (CT) imaging in diagnosing the presence, level, degree, and cause of intestinal obstruction, and the role of CT in detecting presence of complications; ii) to assess impact of CT in decision making and management (surgical/conservative); iii) to correlate CT findings with intra operative findings whenever possible. A prospective study of 40 patients presented in outpatient/emergency department with features suggestive of intestinal obstruction. Multislice contrast enhanced computed tomography of whole abdomen was done in all patients after preliminary investigations. Whenever indicated, patients were explored. Statistical analysis was performed to determine the efficacy of multidetector computed tomography (MDCT) in diagnosing intestinal obstruction and its complications. Out of 40, 30 patients underwent exploratory laparotomy and it was found that MDCT was 85% sensitive and 70% specific in diagnosing bowel obstruction. Association between MDCT findings suggestive of obstruction and intra-operative findings turn out to be significant (P=0.003). MDCT findings were consistent with intraoperative findings in 22 out of 30 patients (73%). MDCT is sensitive and specific in determining the presence of bowel obstruction and should be recommended for patients with suspected bowel obstruction because it affects outcome in these patients.

Highlights

Bowel obstruction was recognized, described and treated by Hippocrates
The etiology can sometimes be determined, but ultrasonography is less accurate than computed tomography (CT)
Several studies have shown the accuracy of multidetector computed tomography (MDCT) scan in diagnosis of bowel obstruction

Summary

Introduction

Bowel obstruction was recognized, described and treated by Hippocrates. The earliest recorded operation as treatment was performed by Praxagoras circa 350 BC, when he created an enterocutaneous fistula to relieve the obstruction of a segment of bowel.[1]. Bowel obstruction is considered to be present when dilated loop measures >2.5 cm and length of segment is >10 cm. Unlike oral contrast radiography, which provides imaging of only the luminal surface, CT allows imaging of the abdominal contents outside the lumen. Because of this advantage, the nature of the obstruction, especially when secondary to an extraluminal or intramural malignant process, can be established.[3] Additional abdominal pathology, such as the presence of nodal or liver metastases, ascites, and solidorgan parenchymal abnormalities, can often be identified, thereby helping to define the cause of the obstruction

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Results

Discussion

Conclusion