Small Bowel Feces Sign Research Articles

Prognostic value of CT findings for conservative treatment failure in adhesive small bowel obstruction.

This study aimed to identify the radiological CT findings that are significantly correlated with the outcome of conservative management with oral water-soluble contrast medium in patients presenting with Adhesive Small Bowel Obstruction (ASBO) to the Emergency Room. In this retrospective single-center study, we considered all consecutive patients admitted to the ER from February 2019 to February 2023 for ASBO with an available contrast-enhanced CT scan performed at diagnosis and treated with conservative management. The investigated CT findings were type and location of transition zone, ASBO degree, fat notch sign, beak sign, small bowel feces sign, presence of peritoneal free fluidand pneumatosis intestinalis. Radiological parameters were analyzed using univariable and multivariable logistic regression to test the significant association between the CT parameters and the target. Among the 106 included patients (median age 74.5years), conservative treatment was effective in 59 (55.7%) and failed in 47 (44.3%), needing delayed surgery. In the failure group, there was a higher prevalence of patients who had previous ASBO episodes (p = 0.03), a greater proportion of females (p = 0.04) and a longer hospital stay (p < 0.001). At multivariable analysis, two CT findings were significantly correlated with failure of conservative treatment: fat notch sign (OR = 2.95; p = 0.04) and beak sign (OR = 3.42; p = 0.04). Two radiological signs correlate with failure of non-operative management in ASBO, suggesting their importance in surgical decision-making. Patients presenting with these signs are at higher risk of unsuccessful conservative treatment and may require undelayed surgical intervention.

CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer.

To identify CT prognostic signs of poor outcomes in acute obstructive colonic cancer (AOCC). Demographic,clinical, laboratory, radiological and surgical dataof65consecutive patients with AOCC who underwent emergency surgery were analyzed. CT examswere reviewed to assess diameters of cecum, ascending, transverse, descending, and sigmoid proximal to the tumor; colon segments' CD/L1-VD ratios,continence of the ileocecal valve, small bowel overdistension, presence of small bowel feces sign and cecalpneumatosis. PostOperative complications (PO), according to the Clavien-Dindo classification, were analyzed. Gender, age and location of the tumor were not predictive factors of complications. Among laboratory exams, CRP was the most important predictive value of PO (OR 8.23). A cecum distension ≥ 9cm represented the critical diameter beyond which perforation and cecal necrosis were found at surgery. Cecal pneumatosis at CT was correlated with cecal necrosis at surgery in < 50% of patients. Pre-operative transverse colon CD/L1-VD ratio ≥ 1.43 and descending colon CD/L1-VD ratio ≥ 1.31 were associated with the development of PO (grade ≥ III-V). PO (grade ≥ III-V) occurred in 18/65 patients. Postoperative complications in emergency surgery of AOCC were not related to the age, sex and tumor's location. Preoperative PCR values (≥ 2.17) predict the development of postoperative complications. CT resulted a valid diagnostic tool toidentify patients at higher risk of complications:a CD/L1-VD ratios with cut-off values of 1.43 (transverse) and 1.31 (descending) predicted major complications(grade ≥ III-V) and a cecum distension ≥ 9cm represented the critical diameter beyond which perforation occurred in > 84% of patients.

Predictive factors for operative intervention and ideal length of non-operative trial in adhesive small bowel obstruction.

Small bowel obstruction (SBO) is responsible for 350,000 U.S. hospitalizations and costs ~ $2.3 billion annually. The current standard of care for SBO is to trial 3 to 5days of non-operative management. This study evaluated the factors associated with operative management. This retrospective cohort study included adult patients admitted with adhesive SBO. Exclusions were for operative intervention within 24h or death. At baseline (N = 360), mean age was 65.9years, 57.8% female, 72.3% white, mean BMI 26.1, 38.7% with history of SBO and 98.1% had history of abdominal surgery. Symptom onset prior to hospitalization was 1-2days. 55.6% had successful non-operative management at discharge (median length of stay 3days) vs. 44.4% operative conversion. In univariate analyses, BMI, SBO history, surgical history, days symptom onset, vitals, abdominal pain, obstipation, acute kidney injury, and lack of small bowel feces sign on CT scan were significantly associated with operative management. In a multivariable logistic regression, after controlling all other variables, a lack of small bowel feces sign (adjusted odds ratio, aOR = 2.25, 95% CI 1.06-4.77, p = 0.04) and history of exploratory laparotomy (aOR = 0.44, 95% CI 0.21-0.90, p = 0.03) were significantly associated with operative management. Time from admission to surgery averaged 3.89days: small bowel resection (55/160) was 4.9days (median = 4), compared to patients without resection (3.4days, median = 2; p = 0.00; OR = 1.2, 95% CI 1.07-1.35). A lack of small bowel feces sign can be a potential indicator for operative management and should be further explored. Since the median resolution of symptoms in the non-operative management group was ~ 2days and a 20% higher odds for bowel resection each day surgery is delayed, the conservative trial period for adhesive SBO should not exceed 3days.

Closed loop obstruction of small bowel: CT signs predicting successful non-surgical treatment

PurposeTo clarify the computed tomography (CT) findings related to successful conservative treatments in patients with closed-loop small bowel obstruction (CL-SBO) without evidence of bowel strangulation. MethodsSixty-four patients (71 CT scans) diagnosed with CL-SBO by CT and received initial conservative treatments from May 2010 to August 2020 were retrospectively included. Two blinded radiologists reviewed the CT findings, including the transition zone (number, distance, and location), maximum bowel diameter, mesenteric haziness, mesenteric fluid, increased unenhanced bowel wall attenuation, decreased bowel wall enhancement, small bowel feces sign, whirl sign, bowel wall thickening, ascites, and degree of obstruction. The findings of the success and failure groups of conservative treatment were compared. Interobserver agreement was assessed for all findings. ResultsAmong the 71 cases, conservative treatments were successful in 42 cases (59 %) but failed in 29 cases (41 %). In multivariable analyses, the distance between the transition zones (>1 cm) and low-degree obstruction were independently associated with successful conservative treatments, with odds ratios of 6.23 and 3.52, respectively. The combination of these two CT findings exhibited a specificity of 89.7 % with a positive likelihood ratio of 3.01. Interobserver agreement of the degree of obstruction and the distance between the transition zones was almost perfect (ĸ = 0.814 and 0.914, respectively). ConclusionsThe distance between the transition zones (>1 cm) and low-grade obstruction are independent CT predictors of successful conservative treatments in CL-SBO patients. Initial conservative treatments are recommended for patients with both CT findings.

Computed tomography with clinical scoring to differentiate phytobezoar from feces in childhood small bowel obstruction.

Identification of phytobezoar in childhood small bowel obstruction (SBO) characterized by smallbowel feces sign (SBFS) is still challenging. The aim of our study was to assess the diagnostic performance of quantitative computed tomography (CT) analysis combined with the Acute General Emergency Surgical Severity-Small Bowel Obstruction (AGESS-SBO) scoring system in determining phytobezoar-related SBO. Sixteen phytobezoar-related SBO were categorized as the phytobezoar group and the other 19 SBFSpositive SBO was categorized as the control group. Demographic data, clinical presentation, and laboratory and CT findings were collected and analyzed. Each patient`s AGESS-SBO score was determined according to the individual medical record. Multivariate logistic regression analyses were used to identify significant variables associated with phytobezoar-related SBO. Diagnostic performance of key variables was assessed using receiver operating characteristic (ROC) curve analysis. Compared to the control group, the phytobezoar group showed a significantly shorter debris maximal length (3.0 ± 0.5 cm vs. 3.5 ± 0.7 cm, P < 0.05), stronger attenuation (12.6 ± 5.9 HU vs. 8.2 ± 4.0 HU, P < 0.05) in CT, and higher AGESS-SBO scores (4.5 [interquartile (IQR): 4-5]) vs. (2 [IQR: 1-4]). With the combination of debris attenuation (with a cut-off of > 9.0 HU) and AGESS-SBO score (with a cut-off of > 3 points), the positive predictive value (PPV) and negative predictive value (NPV) to diagnose phytobezoar-related SBO were 80% (12/15) and 84% (16/19), respectively. The diagnostic method of integrating quantitative CT analysis and the AGESS-SBO scoring system can improve the identification accuracy of phytobezoar in SBFS-positive childhood SBO.

Role of Multidetector computed tomography in clinically suspected acute small bowel obstruction

Aim: To evaluate the role of Multidetector computed tomography in clinically suspected acute small bowel obstruction. Material and methods: The present prospective observational study was on 50 patients with clinical suspicion of acute small bowel obstruction referred to Department of Radio diagnosis, Imaging and interventional radiology from OPD/IPD of C.S.S. Hospital, under the age is of N.S.C.B Subharti Medical College, Meerut. After obtaining clinical history relevant clinical examination was done. CT examinations were done on Philips Ingenuity 128 Slice (MDCT). Imaging and Diagnosis of Small Bowel Obstruction was made as per departmental protocols. We then assessed whether obstruction was present and if present, the level, cause of the obstruction and small bowel feces sign were assessed. Results: 56% of the patients were operated surgically for the management of the SBO while 44% of the subjects were managed conservatively. CT diagnosis predicted true positive and true negative cause of obstruction among 60.71% and 17.86% of the cases while false positive and false negative among 7.14% and 14.29% of the cases. CT diagnosis predicted true positive and true negative finding for the site of obstruction among 57.14% and 25% of the cases while false positive and false negative among 10.71% and 7.14% of the cases. Conclusion: MDCT is highly sensitive and specific in diagnosing cause of obstruction. In addition to primary gut pathology, MDCT can detect various associated and incidental findings which are not suspected clinically.

Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment.

To clarify CT findings that predict outcome of conservative treatment in patients with non-strangulated adhesive small bowel obstruction (SBO). Unenhanced and contrast-enhanced abdominopelvic CT studies in 189 patients with adhesive SBO who had initial conservative treatment were reviewed. The CT findings included transition zone, beak signs, maximum bowel diameter, bowel diameter ratio, decreased bowel wall enhancement, increased unenhanced bowel wall attenuation, anterior parietal adhesion, bowel wall thickening, closed-loop obstruction, small bowel feces sign, whirl sign, mesenteric haziness, mesenteric, peritoneal fluid, and submucosal edema. These findings were statistically compared according to the success or failure of treatment. Conservative treatment succeeded in 144 patients (76.2%) and failed in 45 patients (23.8%). At multivariate analysis, the lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid were independent findings predicting failure of conservative treatment, with odds ratios of 5.23, 5.5, 13.55, and 4.89, respectively. The presence of all significant findings showed a high specificity of 97.2% with positive likelihood ratio of 8.8. If CT scans showed none of the three significant findings, the negative predictive value was 97.6% and negative likelihood ratio was 0.08. The lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid are independent CT findings predicting the failure of conservative treatment in patients with non-strangulated adhesive SBO. The combination of all CT findings suggests the need for surgery; absence of two or all CT findings should suggest an attempt for conservative treatment. • To minimize delayed operation, it is important to identify non-strangulated adhesive small bowel obstruction patients in whom initial conservative treatment is likely to fail. • The lack of small bowel feces sign, the presence of mesenteric haziness, and a moderate amount of mesenteric fluid are independent factors predicting the failure of conservative treatment in patients with non-strangulated adhesive small bowel obstruction. • The combination of all three CT findings suggests the need for surgery; absence of two or all three CT findings should suggest an attempt for conservative treatment.

A clinical and radiographic model to predict surgery for acute small bowel obstruction in Crohn's disease.

For more than half of Crohn's disease patients, strictures will cause bowel obstructions that require surgery within 10years of their initial diagnosis. This study utilizes computed tomography imaging and clinical data obtained at the initial emergency room visit to create a prediction model for progression to surgery in Crohn's disease patients with acute small bowel obstructions. A retrospective chart review was performed for patients who presented to the emergency room with an ICD-10 diagnosis for Crohn's disease and visit diagnosis of small bowel obstruction. Two expert abdominal radiologists evaluated the CT scans for bowel wall thickness, maximal and minimal luminal diameters, length of diseased segment, passage of oral contrast, evidence of penetrating disease, bowel wall hyperenhancement or stratification, presence of a comb sign, fat hypertrophy, and small bowel feces sign. The primary outcome was progression to surgery within 6 months of presentation. The secondary outcome was time to readmission. Forty patients met the inclusion criteria, with 78% receiving medical treatment alone and 22% undergoing surgery within 6months of presentation to the emergency room. Multivariable analysis produced a model with an AUC of 92% (95% CI 0.82-1.00), 78% sensitivity, and 97% specificity, using gender, body mass index, and the radiographic features of segment length, penetrating disease, and bowel wall hyperenhancement. The model demonstrates that routine clinical and radiographic data from an emergency room visit can predict progression to surgery, and has the potential to risk stratify patients, guide management in the acute setting, and predict readmission.

Diagnostic value of a simple scoring system for the diagnosis and treatment of non-emergency small bowel obstruction

In order to improve the diagnostic accuracy and treatment strategy for small bowel obstruction, we developed a non-emergency small bowel obstruction scoring system (0-4). We performed a retrospective analysis on 94 patients diagnosed with mechanical small bowel obstruction at our hospital. Anterior adhesion, small bowel feces sign, scoring system, and the usefulness of small bowel feces subtypes were examined. When the non-emergency small bowel obstruction scores 3-4, 99% were non-emergency obstructions, with the exclusion of strangulated small bowel obstruction. On the contrary, when the non-emergency small bowel obstruction scores 0-1, 47.5% were strangulated small bowel obstruction. As the effectiveness of withholding food and fluids (NPO) or short tube is high (about 70%) when small bowel feces are dry, placing a long tube may not be needed.

A Clinical and Radiographic Model to Guide Medical versus Surgical Management for Acute Small Bowel Obstruction in Crohnʼs Disease

Introduction: Crohn's disease is a chronic inflammatory condition that often leads to stricture formation. For more than half of Crohn's disease patients, the strictures will cause bowel obstructions that require a surgical bowel resection within 10 years of their initial diagnosis. Certain patients may benefit from surgery over prolonged medical management. We evaluated whether CT imaging and clinical criteria obtained at the initial emergency room visit for acute small bowel obstruction are able to predict progression to surgery and readmission. Methods: We performed a retrospective chart review of Crohn's disease patients with acute small bowel obstructions seen in the emergency room. Inclusion criteria included adults (>18 years) admitted with the ICD-10 diagnosis for Crohn's disease and a primary diagnosis of small bowel obstruction. Patients with other causes of small bowel obstructions (e.g. malignancy, adhesions or anastomotic strictures), or without an admission abdominal CT scan with intravenous contrast or a confirmed diagnosis of Crohn's disease were excluded. Two expert abdominal radiologists evaluated the CT scans for bowel wall thickness, maximal and minimal luminal diameters, length of diseased segment, passage of oral contrast, penetrating disease, bowel wall hyperenhancement or stratification, presence of a comb sign, fat hypertrophy, and small bowel feces sign. The primary outcome was progression to surgery (yes/no) and days to readmission. The clinical and radiographic data were analyzed using univariate and multivariable analysis. Results: Forty patients met the inclusion criteria with the majority receiving medical treatment alone (78%) and the minority (22%) underwent surgery. Univariate analysis identified a BMI<25 as a significant predictor for surgery (P=0.04). Multivariable analysis of BMI and radiographic features consisting of involved segment length, penetrating disease, and bowel wall hyperenhancement produced a model that predicted progression to surgery with an AUC of 91% (95%CI 0.80-1.01), 78% sensitivity, and 84% specificity. Kaplan-Meier curves of high-vs. low-risk patients revealed significant separation for the time to readmission (P=0.04). Conclusion: We describe a model based on clinical and radiographic data collected in an emergency room setting that predicts progression to surgery and readmission. The model has the potential to stratify patients, guide management in the acute setting, and assess future risk for readmission.613_A Figure 1 No Caption available.613_B Figure 2 No Caption available.

İnce bağırsak obstrüksiyonlu hastaların tanısında bilgisayarlı tomografi bulgularının rolü

Aim: The goal of this prospective study is to evaluate the prognostic impact of computed tomography (CT) signs in the analysis of small bowel obstruction (SBO). Patients and Method: Sixty consecutive patients with acute abdominal pain who were examined using abdominal CT to diagnose SBO were included in the study. 47 patients of them (26 male; 21 female and mean age, 60 years), were evaluated. CT evaluation parameters were mesenteric congestion, transition zone, feces sign, intramural air and intraperitoneal free fluid. Results: There was a statistically significant association between the SBO diagnosis and CT findings for mesenteric congestion, transition zone and intramural air (p&amp;lt;0.05 for all). These CT signs had greatest sensitivity and positive predictive value (PPV) in diagnosis of SBO. The combination of mesenteric congestion, transition zone and in-tramural air showed a significant association in the diagnosis of SBO (p&amp;lt;0.05). Small bowel feces sign and intraperitoneal free fluid findings had no statistically significant value in the diagnosis of SBO (p&amp;gt;0.05). When three or more CT findings were seen together, there was a statistically significant association in the diagnosis (p&amp;lt;0.05). Conclusion: Mesenteric congestion and transition zone had the highest sensitivity and PPV in diagnosing SBO. The combination of mesenteric congestion, transition zone and intramural air and the presence of three or more CT signs markedly increase the specificity in diagnosis of SBO.

Small bowel obstruction: need for surgery based on history and radiology

Background: Small bowel obstruction is a common clinical challenge because the proper management of small bowel obstruction requires a methodology which on one hand can promptly recognise the presence of strangulation-obstruction and hence the need for urgent operative intervention; and on the other hand, can avoid a non-therapeutic laparotomy along with its associated morbidities and further adhesion formation with its potential sequelae. The study was done to identify relevant features in the patient’s clinical and CT abdomen findings which when present would be highly predictive of the requirement of an operative intervention in a patient with small bowel obstruction.Methods: The study was a hospital based analytical observational study on patients admitted from March 2013 to May 2014 with a diagnosis of small bowel obstruction and who underwent a concurrent CT abdomen. Correlation of line of management was done with respect to the three chosen parameters, obstipation (history), mesenteric edema (CT imaging) and lack of small bowel feces Sign (CT imaging).Results: A total of 74 patients were included with Male:Female ratio being 3.1:1. Forty patients were managed conservatively and remaining underwent surgery with adhesions being the most frequent etiology. The most common operative procedure performed was adhesiolysis with or without band release. Twenty-three cases were performed by open method and remaining laparoscopically. Evaluation of the three parameters revealed that these variables, when present independently or in combination, are predictive for need for operative intervention (p-value &lt;0.001). The sensitivity and specificity to predict the need for exploration when all 3 features were present concurrently was 38.24% and 100%, respectively.Conclusions: Small-bowel obstruction is a common surgical dilemma, the management of which is dealt on a daily basis by surgeons and non-surgeons. The management using variables based on history and radiology may help classify patients into those requiring conservative management and those in need of early exploration.

Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction

Existing trials studying the use of Gastrografin for management of adhesive small bowel obstruction (SBO) are limited by methodological flaws and small sample sizes. We compared institutional protocols with and without Gastrografin (GG), hypothesizing that a SBO management protocol utilizing GG is associated with lesser rates of exploration, shorter length of stay, and fewer complications. A multi-institutional, prospective, observational study was performed on patients appropriate for GG with adhesive SBO. Exclusion criteria were internal/external hernia, signs of strangulation, history of abdominal/pelvic malignancy, or exploration within the past 6 weeks. Patients receiving GG were compared to patients receiving standard care without GG. Overall, 316 patients were included (58 ± 18 years; 53% male). There were 173 (55%) patients in the GG group (of whom 118 [75%] successfully passed) and 143 patients in the non-GG group. There were no differences in duration of obstipation (1.6 vs. 1.9 days, p = 0.77) or small bowel feces sign (32.9% vs. 25.0%, p = 0.14). Fewer patients in the GG protocol cohort had mesenteric edema on CT (16.3% vs. 29.9%; p = 0.009). There was a lower rate of bowel resection (6.9% vs. 21.0%, p < 0.001) and exploration rate in the GG group (20.8% vs. 44.1%, p < 0.0001). GG patients had a shorter duration of hospital stay (4 IQR 2-7 vs. 5 days IQR 2-12; p = 0.036) and a similar rate of complications (12.5% vs. 17.9%; p = 0.20). Multivariable analysis revealed that GG was independently associated with successful nonoperative management. Patients receiving Gastrografin for adhesive SBO had lower rates of exploration and shorter hospital length of stay compared to patients who did not receive GG. Adequately powered and well-designed randomized trials are required to confirm these findings and establish causality. Therapeutic, level III.

The small bowel feces sign.

The small bowel feces sign.

Increased Unenhanced Bowel-Wall Attenuation at Multidetector CT Is Highly Specific of Ischemia Complicating Small-Bowel Obstruction

To evaluate performance of increased bowel-wall attenuation on unenhanced 64-section multidetector computed tomographic (CT) images for diagnosing bowel-wall ischemia in patients with mechanical small-bowel obstruction (SBO) and to evaluate the diagnostic accuracy of multidetector CT in detecting small-bowel ischemia complicating SBO, with surgical and histopathologic findings as reference standard. The local institutional review board approved this retrospective study; informed consent requirement was waived. In 44 patients (10 men, 34 women; age range, 30-100 years) who were admitted because they were suspected of having SBO and treated surgically within the next 7 days, 45 multidetector CT scans were retrospectively reviewed. Two gastrointestinal radiologists performed independent blinded reviews of images to identify specific signs of ischemia; disagreements were resolved in consensus with a third gastrointestinal radiologist. Results were compared with both findings in prospective radiology reports and surgical and histopathologic findings. Fisher exact and χ(2) tests were used to assess associations between CT signs and ischemia, and the κ statistic was used to assess interobserver agreement. In 19 of 45 (42%) multidetector CT scans, ischemia was confirmed at surgery and/or histopathologic examination. Increased bowel-wall attenuation on unenhanced images was significantly associated with ischemia (P < .0001); in this highly selected population, this sign had a 100% (24 of 24) specificity and a 56% (10 of 18) sensitivity. Sensitivity and specificity of multidetector CT for ischemia were 63% (12 of 19) and 92% (24 of 26), respectively, for the prospective reports and 84% (16 of 19) and 96% (25 of 26), respectively, for the consensus review. Decreased segmental bowel-wall enhancement was the most accurate 64-section multidetector CT sign for diagnosing ischemia (sensitivity, 78% [14 of 18]; specificity, 96% [24 of 25]; P < .0001). The small-bowel feces sign was significantly associated with ischemia (P = .0308). Increased bowel-wall attenuation on unenhanced 64-section multidetector CT images is a specific sign for ischemia complicating SBO. Diagnostic accuracy of 64-section multidetector CT for ischemia associated with SBO was excellent.

Increased Unenhanced Bowel-Wall Attenuation at Multidetector CT Is Highly Specific of Ischemia Complicating Small-Bowel Obstruction

Purpose To evaluate performance of increased bowel-wall attenuation on unenhanced 64-section multidetector computed tomographic (CT) images for diagnosing bowel-wall ischemia in patients with mechanical small-bowel obstruction (SBO) and to evaluate the diagnostic accuracy of multidetector CT in detecting small-bowel ischemia complicating SBO, with surgical and histopathologic findings as reference standard. Materials and Methods The local institutional review board approved this retrospective study; informed consent requirement was waived. In 44 patients (10 men, 34 women; age range, 30–100 years) who were admitted because they were suspected of having SBO and treated surgically within the next 7 days, 45 multidetector CT scans were retrospectively reviewed. Two gastrointestinal radiologists performed independent blinded reviews of images to identify specific signs of ischemia; disagreements were resolved in consensus with a third gastrointestinal radiologist. Results were compared with both findings in prospective radiology reports and surgical and histopathologic findings. Fisher exact and χ2 tests were used to assess associations between CT signs and ischemia, and the κ statistic was used to assess interobserver agreement. Results In 19 of 45 (42%) multidetector CT scans, ischemia was confirmed at surgery and/or histopathologic examination. Increased bowel-wall attenuation on unenhanced images was significantly associated with ischemia (P < .0001); in this highly selected population, this sign had a 100% (24 of 24) specificity and a 56% (10 of 18) sensitivity. Sensitivity and specificity of multidetector CT for ischemia were 63% (12 of 19) and 92% (24 of 26), respectively, for the prospective reports and 84% (16 of 19) and 96% (25 of 26), respectively, for the consensus review. Decreased segmental bowel-wall enhancement was the most accurate 64-section multidetector CT sign for diagnosing ischemia (sensitivity, 78% [14 of 18]; specificity, 96% [24 of 25]; P < .0001). The small-bowel feces sign was significantly associated with ischemia (P = .0308). Conclusion Increased bowel-wall attenuation on unenhanced 64-section multidetector CT images is a specific sign for ischemia complicating SBO. Diagnostic accuracy of 64-section multidetector CT for ischemia associated with SBO was excellent. © RSNA, 2013

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

BackgroundIn 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy.RecommendationsIn absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution, surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not decrease recurrence rates or recurrences needing surgery.Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained.Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin decrease incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.Adhesions quantification and scoring maybe useful for achieving standardized assessment of adhesions severity and for further research in diagnosis and treatment of ASBO.

Relationship Between Small Bowel Obstruction and Small Bowel Feces Sign: Four Cases Report

Small bowel obstruction is a commonly encountered clinical condition in emergency departments. Small bowel feces sign (SBFS) is a CT finding that can be detected in small bowel obstruction. SBFs was identified in the abdominal CT examinations of four patients admitted to the emergency department with complaints of abdominal pain and vomiting. Two patients were treated by surgery and two with medication. In these cases were presented to highlight the importance of the SBFs in the treatment algorithm. doi: http://dx.doi.org/10.4021/jmc1429e

Utility of CT for Diagnosis and Management of Small Bowel Obstruction

Wang Q, Chavhan G, Babyn P, et al. Utility of CT in the diagnosis and management of small-bowel obstruction in children. Pediatr Radiol. 2012; 42 (12): 1441– 1448; doi: 10.1007/s00247-012-2497-9[OpenUrl][1][CrossRef][2][PubMed][3] Researchers from The Hospital for Sick Children in Toronto sought to determine the sensitivity of multidetector computed tomography (CT) in identifying the presence, location, and cause of small bowel obstruction (SBO) in children. The investigators analyzed records of children who underwent an abdominal CT for possible SBO at their institution and then subsequently underwent confirmatory abdominal surgery from 2000 to 2010. Two pediatric radiologists reviewed the CT images for signs of obstruction, including presence of small bowel dilation, wall thickening, presence and location of transition points, small bowel feces sign (inspisated feces in a dilated loop of small bowel), and contrast enhancement of the bowel wall, as well as other signs associated with SBO such as air-fluid levels and collapsed bowel beyond an obstruction. The location of obstruction (ie, duodenum, proximal jejunum, mid small bowel, and distal ileum) as well as the cause of SBO were assessed. Reports of plain films of the abdomen performed prior to the CT were also reviewed for the presence, absence, or equivocal findings of SBO. The investigators also … [1]: {openurl}?query=rft.jtitle%253DPediatric%2Bradiology%26rft.stitle%253DPediatr%2BRadiol%26rft.aulast%253DWang%26rft.auinit1%253DQ.%26rft.volume%253D42%26rft.issue%253D12%26rft.spage%253D1441%26rft.epage%253D1448%26rft.atitle%253DUtility%2Bof%2BCT%2Bin%2Bthe%2Bdiagnosis%2Band%2Bmanagement%2Bof%2Bsmall-bowel%2Bobstruction%2Bin%2Bchildren.%26rft_id%253Dinfo%253Adoi%252F10.1007%252Fs00247-012-2497-9%26rft_id%253Dinfo%253Apmid%252F23052726%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1007/s00247-012-2497-9&link_type=DOI [3]: /lookup/external-ref?access_num=23052726&link_type=MED&atom=%2Faapgrand%2F29%2F4%2F40.atom

Relationship Between Small Bowel Obstruction and Small Bowel Feces Sign: Four Cases Report

Small bowel obstruction is a commonly encountered clinical condition in emergency departments. Small bowel feces sign (SBFS) is a CT finding that can be detected in small bowel obstruction. SBFs was identified in the abdominal CT examinations of four patients admitted to the emergency department with complaints of abdominal pain and vomiting. Two patients were treated by surgery and two with medication. In these cases were presented to highlight the importance of the SBFs in the treatment algorithm. J Med Cases. 2013;4(9):636-640 doi: http://dx.doi.org/10.4021/jmc1429e