Kazuaki Nakashima, Presenter: Nothing to Disclose

Hideki Ishimaru MD, Abstract Co-Author: Nothing to Disclose

Toshifumi Fujimoto, Abstract Co-Author: Nothing to Disclose

Takashi Mizowaki, Abstract Co-Author: Nothing to Disclose

Yohjiro Matsuoka MD, Abstract Co-Author: Nothing to Disclose

Masataka Uetani MD, Abstract Co-Author: Nothing to Disclose

Seigo Kimura, Abstract Co-Author: Nothing to Disclose

Sachie Yotsumoto, Abstract Co-Author: Nothing to Disclose

Kazunori Mitarai, Abstract Co-Author: Nothing to Disclose

Kei Kitamura, Abstract Co-Author: Nothing to Disclose

Closed-loop small bowel obstruction (CL-SBO) is associated with a high risk for vascular impairment and considered as a surgical emergency, however, when the bowel is viable, preservation of the bowel is feasible. The aim of this study was to characterize contrast-enhanced CT (CECT) findings predicting bowel necrosis and ischemia in CL-SBO.

Thirty five patients with CL-SBO confirmed by laparotomy (n = 34) or multiplannar reconstruction of thin slice CT images (n = 1) were included. On the basis of the surgical findings, these patients were classified into three groups: necrosis group, (n = 16) and ischemia without necrosis (ischemia group; n = 11), and no ischemia (n = 8). One patient recovered only with conservative management was also included in no ischemia group. Two blinded radiologists retrospectively reviewed CECT including multiplannar reconstruction images, and evaluated 12 CT findings previously reported to be associated with bowel ischemia: (1) wall thickening, (2) target sign, (3) high attenuation of the wall at precontrast CT, (4) wall enhancement, (5) mesenteric edema, (6) whirl sign, (7) enhancement of mesenteric artery and (8) vein, (9) engorgement of the mesenteric veins, (10) small bowel feces, (11) ascites, and (12) intraperitoneal air. Sensitivity and specificity of each findings were compared among the three groups, and logistic regression analysis was performed.  

Intraperitoneal air, high attenuation of the wall, reduced enhancement of mesenteric arteries and small bowel feces sign showed high specificities of 100%, 100%, 89% and 89%, however low sensitivity of 25%, 31%, 44%, 31%, respectively, to predict bowel necrosis in CL-SBO. On multivariate logistic regression analysis, reduced wall enhancement, reduced enhancement of mesenteric veins and lack of the engorgement of the mesenteric veins were significant for predicting bowel necrosis or ischemia (p<0.05).

Reduced enhancement of wall and mesenteric vessels were reliable findings to detect ischemia. On the contrary, engorgement of the mesenteric veins was predictor of viable bowel.

Evaluation of engorgement of mesenteric vein and enhancement of wall and mesenteric vessels would help us to predict bowel ischemia or necrosis in the closed-loop small bowel obstruction.

Nakashima, K, Ishimaru, H, Fujimoto, T, Mizowaki, T, Matsuoka, Y, Uetani, M, Kimura, S, Yotsumoto, S, Mitarai, K, Kitamura, K, CT Findings of Bowel Ischemia in Closed-loop Small Bowel Obstruction.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13018556.html