Eun Ju Ha, Abstract Co-Author: Nothing to Disclose

Jeong Kyong Lee MD, Presenter: Nothing to Disclose

Seung Yon Baek MD, Abstract Co-Author: Nothing to Disclose

Hye-Young Choi MD, PhD, Abstract Co-Author: Nothing to Disclose

To evaluate the value of MDCT in predicting necessity of subsequent operation in patients with small bowel obstruction (SBO) who have equivocal clinical evidence for deciding operation.

For a 10-month period, 67 patients with suspected SBO underwent MDCT. Forty five of 67 patients with confirmed diagnosis and enough follow-up periods were enrolled in this prospective study. Twenty two patients excluded from the study: no SBO (n = 5), distinct cause of SBO, in whom surgery was necessary (n = 5), small bowel perforation (n = 2), colonic obstruction (n = 9), and lost during follow-up (n = 1). All patients were initially treated conservatively. Surgery was performed in eleven patients who developed classical signs of strangulation or did not improve despite a conservative treatment at least for five days. Two radiologists interpreted MDCT in consensus. Checklists included degree of SBO (complete, incomplete high, incomplete low), presence of transition zone, mesenteric vessels with abnormal course. Each of checklists was compared statistically between operated and non-operated groups.

For degree of SBO, 10 patients had complete and one incomplete high in operated group (n = 11). Three were complete, 14 incomplete high and 17 incomplete low in non-operated group (n = 34). All in operated group showed transition zone but only 24 in non-operated group. Mesenteric vessels with abnormal course were present in seven of operated group and in three of non-operated group. Higher degree and more frequent presence of abnormal vascular course were in operated group (p=0.004, p=0.001). But, presence of transition zone was not different in both groups (p=0.089). Sensitivities and specificities of MDCT for predicting subsequent operation were 100% and 58.8% for degree of SBO, 100 % and 29.4 % for transition zone, and 63.6 % and 91.2 % for mesenteric vessels with abnormal course.

Presence of complete SBO and mesenteric vessels showing abnormal course around the transition zone may be useful indicators for predicting subsequent operation in patients with SBO having equivocal clinical evidence for deciding operation.

The accurate prediction of operation using indicators on MDCT in patients with SBO having equivocal clincal evidence may be helpful for shortening hospitalization and promoting better recovery. 

Ha, E, Lee, J, Baek, S, Choi, H, MDCT for Predicting Subsequent Operation in Patients with Small Bowel Obstruction Having Equivocal Clinical Evidence for Deciding Operation.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6019596.html