CT differentiation between necrotic and nonnecrotic small bowel in closed loop and strangulating obstruction

O Makita, I Ikushima, N Matsumoto, K Arikawa, Y Yamashita, M Takahashi
Abdominal Imaging 1999, 24 (2): 120-4

BACKGROUND: The purpose of this study was to evaluate computed tomographic (CT) findings for predicting the presence of intestinal necrosis in patients with closed loop and strangulating obstruction of the small bowel.

METHODS: Twenty-five patients with surgically confirmed closed loop and strangulating obstruction were divided into two groups with (n = 16) and without (n = 9) intestinal necrosis. By using univariate and multivariate statistical procedures, we evaluated the differences in CT findings between the two groups on the basis of the following six findings: bowel dilatation of strangulated loops (bowel dilatation), wall thickening of strangulated intestines (wall thickening), ascites, vascular dilatation of affected mesenteries (vascular dilatation), elevation of mesenteric attenuation (mesenteric attenuation), and radial distribution of the mesenteric vessels (radial distribution).

RESULTS: Of the six findings, ascites, vascular dilatation, mesenteric attenuation, and radial distribution provided significant discriminating findings between the two groups on univariate analysis. On multivariate analysis, mesenteric attenuation was the most important discriminative factor, followed by radial distribution and ascites. Using these three parameters, the CT was correlated with the surgical findings in 15 of the 16 patients in the necrosis group (sensitivity = 93.8%) and in eight of the nine patients in the nonnecrosis group (specificity = 88.9%). The overall accuracy was 92.0%.

CONCLUSIONS: Mesenteric attenuation, radial distribution, and ascites, depicted on CT differentiate well between necrosis and nonnecrosis of the small bowel in patients with closed loop and strangulating obstruction.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"