Comparison among preoperative single-slice CT and multi-slice CT in simple, closed loop and strangulating bowel obstruction

Marco Assenza, Gabriele Ricci, Marina De Vargas Macciucca, Elisabetta Polettini, Emanuele Casciani, Maria Luisa De Cicco, Gianfranco Gualdi, Claudio Modini
Hepato-gastroenterology 2007, 54 (79): 2017-23

BACKGROUND/AIMS: The aim of this study is to compare preoperative single-slice CT (SSCT) and multislice-CT (MSCT) accuracy in the evaluation of patients with bowel obstruction and intestinal necrosis.

METHODOLOGY: 64 patients were enrolled. We analyzed the SSCT scans of 30 patients and the MSCT scans of 34 patients with clinical and abdominal plain film evidence of bowel obstruction. Presence, site, kind, and cause of the obstruction were evaluated; specific signs of strangulating or closed loop obstruction and wall necrosis were also identified. Three radiologists interpreted the CT scans independently; a consensus review was obtained, indicating the need of emergency or delayed surgery. The results were assayed on the basis of surgical findings.

RESULTS: SSCT and MSCT findings of bowel obstruction presented good correlation with the surgical report. Sensitivity, specificity, PPV and NPV were 86.1%; 89.3%; 91.1%; and 83.3% respectively. The k coefficient of interobserver agreement was significant (0.729; p<0.01). A major difference was observed between findings in SSCT and MSCT in detecting intestinal ischemia (p <0.05); a noteworthy statistical difference between these techniques was observed especially in the sensitivity and specificity of the edema, twisting and/or thickening of mesenteric vessels (p<0.05).

CONCLUSIONS: The first objective of abdominal CT in patients with bowel obstruction is to evaluate the need for emergency surgery because delayed operations potentially result in high mortality. A CT presenting high correlation to surgical findings allows a correct surgical timing and planning thanks to the correct identification of site, kind, and causes of bowel obstruction. MSCT presents better results compared to SSCT in assessing intestinal necrosis.

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