Cherry Kim MD, Presenter: Nothing to Disclose

Choong Wook Lee MD, Abstract Co-Author: Nothing to Disclose

Mi-Hyun Kim, Abstract Co-Author: Nothing to Disclose

Gil-Sun Hong MD, Abstract Co-Author: Nothing to Disclose

To assess CT features of small bowel closed loop obstruction (CLO) in patients who need emergency operation within 24 hours, and to compare CT features between patients who need delayed operation and who were recovered by conservative treatment.

From 2009 to 2013, 187 patients were diagnosed as having CLO based on CT results in the emergency room (ER). Among them, 135 patients were enrolled using the exclusion criteria as follows; (a) CLO by peritoneal seeding, (b) CT images without coronal images, and (c) patients who were immediately transferred to other hospital. Clinical decision for treatment strategy was made based on both clinical and CT findings: 51 patients (Group A) were treated surgically within 24 hours and the remaining 84 patients (Group B) were initially decided to be conservatively treated. Among the 84 patients, 27 patients (Subgroup B1) underwent operation after 24 hours due to aggravation of clinical signs, and 57 patients (Subgroup B2) were recovered with conservative treatment only. CT images were analyzed regarding CT features as follows; pre-contrast bowel wall (BW) attenuation, BW enhancement, BW thickening, mesenteric edema, whirling sign, shape of entrapped mesenteric vessels, distance between beaked bowel loops, mesenteric vascular collapseness, and vascular enhancement of mesenteric arteries and veins. CT features were compared between group A and B, and between subgroup B1 and B2 using Fishers exact test and Student t-test.

CT features of group A showed significantly increased pre-contrast BW attenuation, decreased BW enhancement, decreased vascular enhancement of mesenteric arteries and veins, increased BW thickening, severe mesenteric edema and severe mesenteric vascular collapseness than those of group B (all, p<0.001). In subgroup analysis between B1 and B2, all CT features didn’t show any significant differences (all, p>0.05).

In patients who admitted ER with CLO, CT features were quite different between the groups who need emergency operation or not. However, there were no significant CT findings to differentiate the patients who need delayed operation from the patients who were completely recovered with conservative treatment.

In patients with small bowel closed loop obstruction, some CT features could be important factors for clinical decision about emergency operation or initial conservative treatment.

Kim, C, Lee, C, Kim, M, Hong, G, CT Features of Small Bowel Closed Loop Obstruction in Emergency Room: Comparison between Patients Groups according to Treatment Strategies.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016322.html