Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2015; 21(33): 9774-9784
Published online Sep 7, 2015. doi: 10.3748/wjg.v21.i33.9774
Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography
Pei-Yuan Wang, Xia Wang, Lin Zhang, Hai-Fei Li, Liang Chen, Xu Wang, Bin Wang
Pei-Yuan Wang, Lin Zhang, Liang Chen, Xu Wang, Department of Radiology, Affiliated Hospital of Binzhou Medical University, Binzhou 256603, Shandong Province, China
Pei-Yuan Wang, Hai-Fei Li, Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, Shandong Province, China
Pei-Yuan Wang, Bin Wang, Medical Imaging Research Institute, Binzhou Medical University, Yantai 264003, Shandong Province, China
Xia Wang, Department of Pathology, Binzhou Medical University, Yantai 264003, Shandong Province, China
Author contributions: Wang PY and Wang Xia contributed equally to this work; Wang PY and Wang B designed the research; Wang PY, Wang Xia, Zhang L and Li HF performed the research; Li HF contributed new analytic tools; Chen L and Wang Xu analyzed the data; Wang PY and Wang Xia drafted the manuscript; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Binzhou Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bin Wang, PhD, Medical Imaging Research Institute, Binzhou Medical University, No. 346 Guanhai Road, Yantai 264003, Shandong Province, China. binwang001@aliyun.com
Telephone: +86-535-6913002 Fax: +86-535-6913002
Received: January 10, 2015
Peer-review started: January 10, 2015
First decision: March 10, 2015
Revised: April 25, 2015
Accepted: June 16, 2015
Article in press: June 16, 2015
Published online: September 7, 2015
Abstract

AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction (BI-SBO) and to discuss the diagnostic value of multi-slice spiral computed tomography, particularly contrast-enhanced scanning, in this condition.

METHODS: A total of 35 BI-SBO cases treated at our hospital from January 2007 to December 2013 were retrospectively analysed. Complete clinical and computed tomography (CT) data of the patients were available and confirmed by surgery. SBO was clinically diagnosed on the basis of clinical manifestations. Of the 35 patients, 18 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT and 17 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT combined with contrast-enhanced examination. Original images were processed using a GE ADW4.3 workstation to obtain MPR, CPR, MIP and CTA images. The images of all patients were evaluated by two abdominal imaging experts. The main analytical contents of planar scanning included intestinal bezoar conditions, changes in the intestinal wall and changes in peri-intestinal conditions. Vascular hyperaemia and arterial blood supply conditions at a specific obstruction site and the distal end of the obstruction site were evaluated through contrast-enhanced examination.

RESULTS: The proportion of males to females among the 35 cases was 1:1.69 (13:22); median age was 63.3 years. The following cases were observed: 29 (82.8%) cases occurred in autumn and winter and showed a history of consuming high amounts of persimmon and hawthorn; 19 (54.3%) cases revealed a history of gastrointestinal surgery; 19 exhibited incomplete dentition, with missing partial or whole posterior teeth; 26 suffered from obstruction at the ileum. A total of 51 bezoars were found in these patients, of whom 16 (45.7%) had multiple bezoars. CT planar scanning of bezoars showed lumps with mottled gas inside the intestinal cavity. Furthermore, 9 cases of bezoars had envelopes and 11 cases were accompanied with thickening of the distal wall of the obstructed bowel. Scanning of 17 cases was enhanced; the results revealed that the mesenteric blood vessels at the obstruction site and the proximal site were dilated, and a total of 7 cases were accompanied with distal vascular dilation and intestinal wall thickening.

CONCLUSION: BI-SBO exhibits regional and seasonal characteristics. CT planar and contrast-enhanced scanning can be applied to diagnose and observe vascular conditions in obstructed zones.

Keywords: Small bowel obstruction, Bezoar, Multi-slice computed tomography

Core tip: Bezoar-induced small bowel obstruction (BI-SBO) is a relatively rare clinical condition. BI-SBO exhibits regional and seasonal characteristics. This condition is associated with various predisposing factors. Multi-slice spiral computed tomography planar scanning can reveal intestinal bezoar conditions and changes in the intestinal wall and peri-intestinal conditions. Contrast-enhanced examination can further reveal vascular conditions, such as vascular hyperaemia and arterial blood supply conditions, in obstructed zones.