American Journal of Roentgenology, Vol 166, 67-71, Copyright © 1996 by American Roentgen Ray Society

ARTICLES

Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT

D Frager, JW Baer, SW Medwid, A Rothpearl and P Bossart
Department of Radiology, Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, New York, NY 10025, USA.

OBJECTIVE. The purpose of this study was to determine whether CT can be used to diagnose ischemia of the small intestine in patients with small- bowel obstruction due to adhesions or hernia. SUBJECTS AND METHODS. During a 12-month period, 60 patients underwent surgery for complete or high-grade small-bowel obstruction due to adhesions or hernia, and 29 (48%) had evidence of associated intestinal ischemia. All of these patients had been preoperatively diagnosed by CT as having high-grade small-bowel obstruction. At the same time, a prospective determination was made based on the CT as to whether there was any associated intestinal ischemia. All CT scans were performed within 24 hours of the operation. A CT diagnosis of ischemia was based on the presence of two or more of the following signs: bowel-wall thickening, high attenuation of the bowel wall on unenhanced CT scans, mesenteric edema or fluid, asymmetric bowel-wall enhancement on i.v. contrast-enhanced CT scans, pneumatosis, or portal venous gas. Results of the CT examination and surgical findings were then compared. Further evaluation was done with a retrospective multivariate discriminant analysis. RESULTS. Ischemia was prospectively diagnosed on the basis of CT findings in 41 (68%) of the 60 patients. There were no false-negative CT diagnoses (sensitivity, 100%); however, there were 12 CT diagnoses that were false-positive (specificity, 61%). The multivariate analysis corroborated the prospective results by showing high sensitivity (90%) and diminished specificity (50-64%). Bowel-wall thickening and high attenuation of the bowel wall were the most important signs of ischemia on unenhanced CT scans, whereas abnormal bowel-wall enhancement and mesenteric fluid correlated best on enhanced CT examinations. CONCLUSIONS. CT is a sensitive but not completely specific preoperative indicator of intestinal ischemia in patients with small-bowel obstruction due to hernias or adhesions.
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