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CT of Small-Bowel Obstruction in Children

Sensitivity and Specificity

Amal A. Jabra1, John Eng2, Christopher G. Zaleski3, George E. Abdenour, Jr.1, Hao V. Vuong4, Uwa O. Aideyan1 and Elliot K. Fishman2

1 Department of Radiology, University of Miami School of Medicine, Jackson Memorial Medical Center, West Wing 279, 1611 N.W. 12th Ave., Miami, FL 33136.
2 Department of Radiology, The Johns Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287.
3 Nemours Children's Clinic, 807 Nira St., P. O. Box 5720, Jacksonville, FL 32247.
4 Department of Radiology, Baptist Hospital, 8900 N. Kendall Dr., Miami, FL 33176.



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  		Fig. 1. —8-month-old boy with small-bowel obstruction resulting from adhesions. CT scan with IV contrast medium shows difference in bowel caliber with proximal dilated small bowel (straight arrows) filled predominantly with fluid and collapsed distal small bowel (curved arrows). Ascites is present.

 


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  		Fig. 2. —17-year-old boy with small-bowel obstruction. CT scan was obtained 5 days after right nephrectomy for trauma. Obstruction was produced by combination of adhesions, segmental volvulus, and ileoilial intussusception related to Meckle's diverticulum. Scan shows intussusception (arrowheads). Also note small-bowel dilatation and collapsed colon (arrows).

 


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  		Fig. 3. —12-year-old girl presenting with feeding intolerance and abdominal distention. Patient had undergone previous Nissen fundoplication and spinal instrumentation, which produced artifact. CT scan shows several localized mildly dilated air-filled small-bowel loops resulting from compression and entrapment by adhesive bands. Note typical hairpin appearance of bowel loop (arrows) frequently seen in closed-loop obstruction. Diagnosis of obstruction was missed by both interpreters.

 


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  		Fig. 4. —16-year-old boy with ileus. CT scan shows generalized small-bowel dilatation (straight arrows) as well as dilatation of ascending colon (curved arrow).

 


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  		Fig. 5. —Graph of fitted receiver operating characteristic curve for the detection of small-bowel obstruction among the subset of abnormal cases. The area under the curve is 0.84, with a standard deviation of 0.06.

 


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  		Fig. 6. —8-month-old girl with prolonged abdominal distention. CT scan obtained 23 days after exploratory laparatomy for unresectable neuroblastoma shows area of ileoileal intussusception (arrows) causing obstruction, which was missed by both interpreters. Note lack of fat density in intussusceptum.

 


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  		Fig. 7. —Segmental small-bowel volvulus in 7-year-old girl. CT scan shows whirl sign (arrows) produced by twisted mesenteric vessels.

 

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