American Journal of Roentgenology, Vol 167, 1451-1455, Copyright © 1996 by American Roentgen Ray Society

ARTICLES

Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction

DD Maglinte, BL Reyes, BH Harmon, FM Kelvin, WW Turner Jr, JE Hage, AC Ng, GT Chua and SN Gage
Department of Radiology, Methodist Hosptial of Indiana, Indianapolis 46202, USA.

OBJECTIVE: We compare the reliability and define the role of plain film radiography and CT in the assessment of various severities of small- bowel obstruction. MATERIALS AND METHODS: A blinded retrospective analysis was done on 78 patients who underwent plain abdominal radiography, CT, and enteroclysis to assess for suspected small-bowel obstruction. The findings at enteroclysis and the clinical outcomes were used as standards of reference. RESULTS: The sensitivity of plain film radiography for revealing small-bowel obstruction was 69% (44/64), and its specificity was 57% (8/14). Overall accuracy of plain film radiography was 67% (52/78). The sensitivity and specificity of CT were 64% (41/64) and 79% (11/ 14), respectively. Overall accuracy of CT was 67% (52/78). When obstructions were classified as low- and high-grade partial obstruction, plain film radiography and CT had sensitivities of 86% (24/28) and 82% (23/28), respectively, for high-grade obstruction and 56% (20/36) and 50% (18/36), respectively, for low-grade obstruction. CT revealed the cause of the small-bowel obstruction in 95% (39/41) of those patients in who CT correctly showed the obstruction. CONCLUSION: Plain film radiography and CT had similar overall accuracies in showing small-bowel obstruction of various severities. Plain film radiography should remain the initial method of imaging patients with suspected small-bowel obstruction. The ability of CT to show the cause of small-bowel obstruction makes CT an important additional diagnostic tool when specific management issues must be addressed.
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