Min Yeong Kim MD, Presenter: Nothing to Disclose

Yong-Soo Kim MD, PhD, Abstract Co-Author: Nothing to Disclose

Youngseo Cho MD, Abstract Co-Author: Nothing to Disclose

Woo Kyoung Jeong MD, Abstract Co-Author: Nothing to Disclose

Adhesive ileus is the most common cause of small bowel obstruction. The small bowel feces sign (SBFS) is presented as mottled, feces-like content within the dilated small bowel loops proximal to obstructed segment on CT scan. The purpose of this study is to determine operation or not in the cases of small bowel adhesive ileus according to the SBFS.

During two years 78 patients with adhesive small bowel ileus were included and 25 patients of them underwent adhesiolysis or segmental resection of small bowel but the others did not. Three abdominal radiologists retrospectively reviewed portal phase CT scans and analyzed the location, length & maximal diameter of dilated small bowel loop, the presence of the presence of beak sign, as well as the presence, length and grade of concretion (grade 1; several mottled lesion floating in the fluid nondependently, grade 2; fluid and mottled lesion half and half, grade 3; looks like feces) of SBFS in consensus. Hospitalization days were also counted. Statistical analysis was performed to determine statistically significant CT findings for conservative management of adhesive ileus using the Student’s t test and Chi-square test.  

Significant difference in the presence of SBFS was found between operative and nonoperative patients (P<0.0005). Only 7 (28%) of 25 operation group showed SBFS while 38 (71.7%) of 53 nonoperation group did. Presence of beak sign (P<0.05) was statistically significant. 18 (72%) of 25 operation group showed beak sign while 25 (47.2%) of 53 nonoperation group did. The hospitalization days of patients with SBFS were shorter (average 7.8 days) than non visualized group (average 20.5 days) in the non operative group (P<0.005).

The patients with SBFS in the adhesive ileus should be managed conservative, whereas the small bowel beak sign suggest operative condition. Therefore SBFS is a good prognostic value in the adhesive ileus.

Presence of small bowel feces sign (SBFS) in the adhesive small bowel ileus is not suggested operative condition but improved by conservative management. It means a good prognostic value.

Kim, M, Kim, Y, Cho, Y, Jeong, W, Operation or Not Adhesive Small Bowel Ileus; Focus on the Predictive Value of Small Bowel Feces Sign (SBFS).  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006552.html