Small bowel obstruction in the pediatric patient: CT evaluation

Abstract

Little has been written about the use of computed tomography (CT) in the evaluation of small bowel obstruction (SBO) in children. The purpose of this study is to review the CT findings of SBO in a pediatric series and to increase awareness of CT as potential problem-solving tool for SBO in children. The medical, surgical, radiographic, and CT scan records of 20 consecutive children with surgically proven SBO were retrospectively reviewed. Duodenal and neonatal obstruction was excluded. CT scans were evaluated for small and large bowel caliber, bowel wall thickening, the appearance of the mesentery, extraluminal abnormalities, and the ability to detect the cause of obstruction. Causes of obstruction included adhesions (nine), small bowel intussusception (four), abscess (two), segmental volvulus (two), Crohn disease (one), focal stricture (one), and internal hernia (one). Small bowel dilatation was present in 19/20 children. Small bowel caliber transition was noted in 17/19 children. Two children with no small bowel caliber transition had a collapsed colon. The colon appeared normal in caliber in nine children, collapsed in nine, and filled with stool proximally and collapsed distally in two. Small bowel thickening was present in six children and mesenteric venous engorgement in three. Specific causes of obstruction were identified on CT in nine children (45%) and could be correctly predicted in seven of nine children with adhesions. In four children, the causes were either not evident or alternate diagnoses could be made. CT can be a useful adjunct in evaluating the presence or causes of SBO in children.