Bowel obstruction CT: Difference between revisions

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Latest revision as of 16:03, 27 February 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Abdominal CT scan may be helpful in the diagnosis of bowel obstruction. Findings on CT scan suggestive of bowel obstruction include dilated bowel loops with air-fluid level, distal collapsed bowel, in addition to, "Target", "Whirl" and "Venous cut-off" signs.

CT scan

Abdominal CT scan may be helpful in the diagnosis of bowel obstruction. Findings on CT scan suggestive of bowel obstruction include:^[1]^[2]^[3]^[4]^[5]
- Dilated bowel loops with air-fluid level
- Distal collapsed bowel
  - Additional signs:
    - "Target sign" – indicates intussusception
    - "Whirl sign" – indicates volvulus
    - "Venous cut-off sign" - indicates thrombosis
    - Ascites
    - Edema of the mesentery and submucosal edema
    - Hemorrhage
    - Bowel wall thickness exceeding 3mm

A non-straight border indicates a small bowel obstruction on CT by James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15997133

Advantages over X-ray

CT scan can determine the following over plain X-ray:
- Specific site of obstruction
- Severity of obstruction
  - Complete or partial
- Etiology
  - Such as a hernia or mass or inflammations
- Complications
  - Such as ischemia, necrosis, and perforations

Timing of CT scan

It is recommended to perform an X-ray first, especially if intervention is needed immediately, since X-rays are readily available, afford less radiation to the patient and are more cost effective.
However, CT scan is more effective at determining those cases that need surgical intervention and can provide more surgical detail.

Sensitivity and specificity of CT scanning according to slice margin

Slice thickness (mm)	Sensitivity	Specificity
50	79	87
5 -10	87	81
0.75	96	100

The comparison table for diagnostic studies of choice for bowel obstruction^[5]

	Sensitivity	Specificity
CT	93%	100%
X-ray	50%	75%

References

↑ Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J (2011). "Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery". World J Emerg Surg. 6: 5. doi:10.1186/1749-7922-6-5. PMC 3037327. PMID 21255429.
↑ Mullan CP, Siewert B, Eisenberg RL (2012). "Small bowel obstruction". AJR Am J Roentgenol. 198 (2): W105–17. doi:10.2214/AJR.10.4998. PMID 22268199.
↑ Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I (2007). "Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome". World J. Gastroenterol. 13 (3): 432–7. PMC 4065900. PMID 17230614.
↑ Balthazar EJ (1994). "George W. Holmes Lecture. CT of small-bowel obstruction". AJR Am J Roentgenol. 162 (2): 255–61. doi:10.2214/ajr.162.2.8310906. PMID 8310906.
↑ ^5.0 ^5.1 Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD (1999). "Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction". Acta Radiol. 40 (4): 422–8. PMID 10394872.

Template:WikiDoc Sources

[pmid21255429-1] Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J (2011). "Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery". World J Emerg Surg. 6: 5. doi:10.1186/1749-7922-6-5. PMC 3037327. PMID 21255429.

[pmid22268199-2] Mullan CP, Siewert B, Eisenberg RL (2012). "Small bowel obstruction". AJR Am J Roentgenol. 198 (2): W105–17. doi:10.2214/AJR.10.4998. PMID 22268199.

[pmid17230614-3] Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I (2007). "Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome". World J. Gastroenterol. 13 (3): 432–7. PMC 4065900. PMID 17230614.

[pmid8310906-4] Balthazar EJ (1994). "George W. Holmes Lecture. CT of small-bowel obstruction". AJR Am J Roentgenol. 162 (2): 255–61. doi:10.2214/ajr.162.2.8310906. PMID 8310906.

[pmid10394872-5] 5.0 ^5.1 Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD (1999). "Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction". Acta Radiol. 40 (4): 422–8. PMID 10394872.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Bowel obstruction}}
-{{CMG}}
+{{CMG}};{{AE}}{{HM}}
-Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
+==Overview==
+Abdominal [[CT scan]] may be helpful in the diagnosis of bowel obstruction. Findings on [[CT scan]] suggestive of bowel obstruction include dilated [[bowel]] loops with air-fluid level, distal collapsed [[bowel]], in addition to, "Target", "Whirl" and "[[Venous]] cut-off" signs.
+==CT scan==
+*Abdominal [[CT scan]] may be helpful in the diagnosis of bowel obstruction. Findings on [[CT scan]] suggestive of bowel obstruction include:<ref name="pmid21255429">{{cite journal |vauthors=Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J |title=Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery |journal=World J Emerg Surg |volume=6 |issue= |pages=5 |year=2011 |pmid=21255429 |pmc=3037327 |doi=10.1186/1749-7922-6-5 |url=}}</ref><ref name="pmid22268199">{{cite journal |vauthors=Mullan CP, Siewert B, Eisenberg RL |title=Small bowel obstruction |journal=AJR Am J Roentgenol |volume=198 |issue=2 |pages=W105–17 |year=2012 |pmid=22268199 |doi=10.2214/AJR.10.4998 |url=}}</ref><ref name="pmid17230614">{{cite journal |vauthors=Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I |title=Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome |journal=World J. Gastroenterol. |volume=13 |issue=3 |pages=432–7 |year=2007 |pmid=17230614 |pmc=4065900 |doi= |url=}}</ref><ref name="pmid8310906">{{cite journal |vauthors=Balthazar EJ |title=George W. Holmes Lecture. CT of small-bowel obstruction |journal=AJR Am J Roentgenol |volume=162 |issue=2 |pages=255–61 |year=1994 |pmid=8310906 |doi=10.2214/ajr.162.2.8310906 |url=}}</ref><ref name="pmid10394872">{{cite journal |vauthors=Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD |title=Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction |journal=Acta Radiol |volume=40 |issue=4 |pages=422–8 |year=1999 |pmid=10394872 |doi= |url=}}</ref>
+**Dilated [[bowel]] loops with air-fluid level
+**Distal collapsed [[bowel]]
+***Additional signs:
+****"Target sign" – indicates [[intussusception]]
+****"Whirl sign" – indicates [[volvulus]]
+****"Venous cut-off sign" - indicates [[thrombosis]]
+****[[Ascites]]
+****[[Edema]] of the [[mesentery]] and [[submucosal]] [[edema]]
+****[[Hemorrhage]]
+****[[Bowel]] wall thickness exceeding 3mm
+[[Image:PSBOCT.png|thumb|center|500px|A non-straight border indicates a small bowel obstruction on CT by James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15997133 ]]
+===Advantages over X-ray===
+*[[CT scan]] can determine the following over plain [[X-ray]]:
+**Specific site of obstruction
+**Severity of obstruction
+***Complete or partial
+**[[Etiology]]
+***Such as a [[hernia]] or [[Mass (medicine)|mass]] or inflammations
+**Complications
+***Such as [[ischemia]], [[necrosis]], and [[Perforation|perforations]]
+===Timing of CT scan===
+*It is recommended to perform an [[X-ray]] first, especially if intervention is needed immediately, since [[X-rays]] are readily available, afford less [[radiation]] to the patient and are more cost effective.
+*However, [[CT scan]] is more effective at determining those cases that need surgical intervention and can provide more surgical detail.
+===Sensitivity and specificity of CT scanning according to slice margin===
-==Overview==
+{| class="wikitable"
-Contrast enema or small bowel series or [[CT scan]] can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.
+!Slice thickness (mm)
+!Sensitivity
+!Specificity
+|-
+|50
+|79
+|87
+|-
+|5 -10
+|87
+|81
+|-
+|0.75
+|96
+|100
+|}
-==CT==
+==== The comparison table for diagnostic studies of choice for bowel obstruction<ref name="pmid10394872">{{cite journal |vauthors=Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD |title=Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction |journal=Acta Radiol |volume=40 |issue=4 |pages=422–8 |year=1999 |pmid=10394872 |doi= |url=}}</ref> ====
-<div align="left">
+{|
-<gallery heights="175" widths="175">
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-Image:Small bowel obstruction 002.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
+! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
-Image:Small bowel obstruction 003.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
-Image:Small bowel obstruction 004.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
-Image:Small bowel obstruction 005.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
+|-
-</gallery>
+! style="background: #696969; color: #FFFFFF; text-align: center;" |CT
-</div>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |93%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
+|-
+! style="background: #696969; color: #FFFFFF; text-align: center;" |X-ray
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |50%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |75%
+|}
 ==References==
 {{Reflist|2}}
-[[Category:Needs content]]
+[[Category:Surgery]]
-[[Category:General surgery]]
-[[Category:Medical emergencies]]
 [[Category:Gastroenterology]]
+[[Category:Up-To-Date]]
 [[Category:Emergency medicine]]
-[[Category:Disease]]
-[[Category:Intensive care medicine]]
+[[Category:Radiology]]
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