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Sohail AH, Hurwitz JC, Silverstein J, Hakmi H, Sajan A, Ye IB, Pacheco TBS, Zielinski GR, Gangwani MK, Petrone P, Levine J, Kella V, Brathwaite CEM, Goparaju A. Predictors of Length of Hospital Stay After Reduction of Internal Hernia in Patients With a History of Roux-en-Y Gastric Bypass. Am Surg 2024; 90:1255-1259. [PMID: 38227350 DOI: 10.1177/00031348241227215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND Postoperative internal hernias after Roux-en-Y gastric bypass (RYGB) have an incidence of 2%-9% and are a surgical emergency. Evidence on factors associated with length of stay (LOS) after emergent internal hernia reduction in RYGB patients is limited. METHODS This is a retrospective review of patients who underwent internal hernia reduction after RYGB at our tertiary care center over a 5 year period from 2015 to 2020. Demographics, comorbidities, and intra- and postoperative hospital course were collected. Univariate and multivariate linear regressions were used to investigate factors associated with LOS. RESULTS We identified 38 patients with internal hernia after RYGB. These patients with mean age 44.1 years were majority female (71.1%) and white race (60.5%). Of the 24 patients where the RYGB was done at our institution, the mean RYGB to IH interval was 43 months. Petersen's defect (57.8%) followed by jejuno-jejunal mesenteric defect (31.6%) were the most common locations for IH. Both Petersen's and jejuno-jejunal mesenteric hernias were found in 4 cases (10.5%). Revision of bypass and small bowel resection were required in 13.2% and 5.3% of cases, respectively. The median (interquartile range) length of stay (LOS) was 2 days. On the multivariate analysis, male sex (P = .019), conversion to exploratory laparotomy (P = .005), and resection of small bowel (P < .001) were independent risk factors for increased LOS. CONCLUSION The most common location of IH after RYGB is Petersen's defect, followed by jejuno-jejunal mesenteric defect. LOS was significantly associated with male sex, exploratory laparotomy, and resection of small bowel.
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Affiliation(s)
- Amir H Sohail
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Joshua C Hurwitz
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Jeffrey Silverstein
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Hazim Hakmi
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Abin Sajan
- Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Ivan B Ye
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | | | - Gregory R Zielinski
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Manesh Kumar Gangwani
- Department of Medicine, University of Toledo - Health Science Campus, Toledo, OH, USA
| | - Patrizio Petrone
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Jun Levine
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Venkata Kella
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Collin E M Brathwaite
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
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Zhou J, Cong R, Shi J, Chen F, Zhu J, Xiao J, Sheng M, Yang J, He B. Diagnostic significance of multidetector computed tomography (MDCT) in patients with small bowel obstruction: a meta-analysis. Jpn J Radiol 2020; 38:458-462. [PMID: 32189176 DOI: 10.1007/s11604-020-00923-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/21/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess the diagnostic value of multidetector computed tomography (MDCT) in small bowel obstruction (SBO) patients. METHODS Relevant literature was searched from the Cochrane Library, Pubmed and Embase. The extracted effective data was calculated using the Meta-Disc 1.4 software; statistical heterogeneity was evaluated using Cochran's Q test and I2. RESULTS A total of five articles were selected for the meta-analysis. In addition, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), as well as the diagnostic odds ratio (DOR) were 0.878 (95% CI 0.822-0.921), 0.807 (95% CI 0.753-0.854), 8.137 (95% CI 2.268-29.192), 0.127 (95% CI 0.040-0.4078) and 72.384 (95% CI 10.841-483.31), respectively. Furthermore, the AUC was 0.9648 with the Q of 0.9116. CONCLUSIONS The data suggest that MDCT is an effective method for diagnosis of SBO.
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Affiliation(s)
- Jie Zhou
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No. 6 Hai Er Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Ruochen Cong
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No. 6 Hai Er Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Jianhua Shi
- Department of Biochemistry, Nantong University Medical School, Nantong, 226019, Jiangsu, China
| | - Feixiang Chen
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No. 6 Hai Er Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Jianfeng Zhu
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No. 6 Hai Er Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, 226019, Jiangsu, China
| | - Meihong Sheng
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No. 6 Hai Er Xiang North Road, Nantong, 226001, Jiangsu, China
| | - Jushun Yang
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No. 6 Hai Er Xiang North Road, Nantong, 226001, Jiangsu, China.
| | - Bosheng He
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No. 6 Hai Er Xiang North Road, Nantong, 226001, Jiangsu, China.
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Li Z, Zhang L, Liu X, Yuan F, Song B. Diagnostic utility of CT for small bowel obstruction: Systematic review and meta-analysis. PLoS One 2019; 14:e0226740. [PMID: 31887146 PMCID: PMC6936825 DOI: 10.1371/journal.pone.0226740] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To perform a systematic review and meta-analysis evaluating the diagnostic performance of computed tomography (CT) for small bowel obstruction (SBO), including diagnostic accuracy, ischemia, predicting surgical intervention, etiology and transition point. METHODS PubMed/MEDLINE and related databases were searched for research articles published from their inception through August 2018. Findings were pooled using bivariate random-effects and summary receiver operating characteristic curve models. Meta-regression and subgroup analyses were performed to evaluate whether publication year, patient age, enhanced CT, slice thickness and pathogenesis affected classification accuracy. RESULTS In total, 45 studies with a total of 4004 patients were included in the analysis. The pooled sensitivity and specificity of CT for SBO were 91% (95% confidence interval [CI]: 84%, 95%) and 89% (95% CI: 81%, 94%), respectively, and there were no differences in the subgroup analyses of age, publication year, enhanced CT and slice thickness. For ischemia, the pooled sensitivity and specificity was 82% (95% CI: 67%, 91%) and 92% (95% CI: 86%, 95%), respectively. No difference was found between enhanced and unenhanced CT based on subgroup analysis; however, high sensitivity was found in adhesive SBO compared with routine causes (96% vs. 78%, P = 0.03). The pooled sensitivity and specificity for predicting surgical intervention were 87% and 73%, respectively. The accuracy for etiology of adhesions, hernia and tumor was 95%, 70% and 82%, respectively. In addition, the pooled sensitivity and specificity for transition point was 92% and 77%, respectively. CONCLUSIONS CT has considerable accuracy in diagnosis of SBO, ischemia, predicting surgical intervention, etiology and transition point.
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Affiliation(s)
- Zhengyan Li
- Division of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ling Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xijiao Liu
- Division of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Fang Yuan
- Division of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Song
- Division of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Murata M, Hiraki M, Hagiwara A, Sawami H, Suzuki R, Fukunaga H, Tanaka N, Inoue A, Takahashi H, Morita S. 3D Vessel Image Reconstruction by MDCT for Surgical Indication and Timing of Strangulating Small Bowel Obstructions. World J Surg 2019; 44:1105-1112. [PMID: 31811338 DOI: 10.1007/s00268-019-05310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with strangulating small bowel obstructions (SBOs) can rapidly deteriorate, in condition; therefore, immediate and appropriate diagnosis is required. However, some cases of SBO are difficult to diagnose using axial computed tomography (CT) images alone. The impact of 3D vessel imaging for the diagnosis, surgical indication, and timing of strangulating SBOs was investigated, prospectively. METHODS Clinical data were collected for 111 strangulating SBOs and 48 simple SBOs from patients receiving surgical interventions from January 2009 to March 2018. The accuracy of preoperative diagnoses for the type of SBO was evaluated. Among 159 patients, 27 underwent contrast-enhanced CT imaging as well as prospectively reconstructed 3D vessel imaging of the superior mesenteric artery, vein, and branches. The concordance rate of operative findings and preoperative diagnoses of the type of SBO were compared between axial CT imaging alone and combination of axial and 3D vessel imaging. RESULTS Overall concordance rate of diagnosis for the type of SBO by axial imaging was 93.1% and that of strangulating and simple SBOs was 92.8% and 93.8%, respectively. Combined axial and 3D vessel imaging resulted in 100% accuracy of preoperative diagnoses for both types of SBO. In addition, abnormalities could be classified from 3D vessel images as central twists or peripheral twists, and deteriorated vascular flow could also be detected. CONCLUSIONS The combination of axial imaging and 3D vessel imaging can be used to accurately diagnose SBOs, and this imaging technique may be useful for determining the surgical indication and suitable timing of strangulating SBOs.
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Affiliation(s)
- Masaru Murata
- Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan.
| | - Masayuki Hiraki
- Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan
| | - Akira Hagiwara
- Department of Radiology, Itami City Hospital, Itami-shi, Hyogo, Japan
| | - Hirokazu Sawami
- Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan
| | - Rei Suzuki
- Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan
| | - Hiroki Fukunaga
- Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan
| | - Nobuo Tanaka
- Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan
| | - Akira Inoue
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata-shi, Osaka, 573-8511, Japan
| | - Hidekazu Takahashi
- Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan
| | - Shunji Morita
- Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan
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Lanzetta MM, Masserelli A, Addeo G, Cozzi D, Maggialetti N, Danti G, Bartolini L, Pradella S, Giovagnoni A, Miele V. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:20-37. [PMID: 31085971 PMCID: PMC6625567 DOI: 10.23750/abm.v90i5-s.8344] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Indexed: 12/16/2022]
Abstract
Although internal hernias are uncommon, they must be beared in mind in the differential diagnosis in cases of intestinal obstruction, especially in patients with no history of previous surgery or trauma. Because of the high possibility of strangulation and ischemia of the affected loops, internal hernias represent a potentially life-threatening condition and surgical emergency that needs to be quickly recognized and managed promptly. Imaging plays a leading role in the diagnosis and in particular multidetector computed tomography (MDCT), with its thin-section and high-resolution multiplanar reformatted (MPR) images, represents the first line image technique in these patients. The purpose of the present paper is to illustrate the characteristic anatomic location, the clinical findings and the CT appearance associated with main types of internal hernia, including paraduodenal, foramen of Winslow, pericecal, sigmoid-mesocolon- and trans-mesenteric-related, transomental, supravesical and pelvic hernias. (www.actabiomedica.it)
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Kuang LQ, Tang W, Li R, Cheng C, Tang SY, Wang Y. Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations. World J Gastroenterol 2019; 25:1100-1115. [PMID: 30862998 PMCID: PMC6406184 DOI: 10.3748/wjg.v25.i9.1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography (MDCT) examination of patients with small bowel obstruction (SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques. AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia. METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients' MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence, agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia. RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3 (P < 0.01), but the results of the two readers using the same protocol were not different (P > 0.05). Using protocol 3, both readers added multiple post-processing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1 (P < 0.01), but no difference was detected between protocols 2 and 3 (P > 0.05). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia. CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.
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Affiliation(s)
- Lian-Qin Kuang
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| | - Wei Tang
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Ran Li
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| | - Cheng Cheng
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| | - Shuang-Yue Tang
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
| | - Yi Wang
- Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
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ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. J Am Coll Radiol 2018; 15:S217-S231. [DOI: 10.1016/j.jacr.2018.09.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023]
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Kim SH, Park KN, Kim J, Eun CK, Park YM, Oh MK, Choi KH, Kim HJ, Kim DW, Choo HJ, Cho JH, Oh JH, Park HY. Accuracy of Plain Abdominal Radiography in the Differentiation between Small Bowel Obstruction and Small Bowel Ileus in Acute Abdomen Presenting to Emergency Department. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction Our purpose was to evaluate whether plain abdominal radiography (PAR) could accurately differentiate between small bowel obstruction (SBO) and small bowel ileus (SBI) in an emergency setting. We also evaluated the value of known classic signs on the PAR for differentiating between SBO and SBI. Methods This retrospective study included 216 emergency room patients who had small bowel distension (maximal small bowel diameter ≥2.5 cm) on the PAR and who underwent successive abdominal computed tomography. One radiologist and one emergency physician retrospectively reviewed PAR in consensus, unaware of the patients' clinical data; they divided the patients into an SBO group and an SBI group according to the radiographic findings. Presence or numeric values of 10 radiographic signs were also recorded. Final diagnoses of SBO and SBI were established by a combined analysis of medical charts, surgical records, radiographic findings on abdominal computed tomography, and small bowel studies. The differential diagnoses based on PAR and the final diagnoses were compared, and the sensitivity and specificity of PAR were calculated. We also evaluated the differences among 10 radiographic signs between the final SBO and SBI groups. Results Sensitivity and specificity of PAR for SBO were 82.0% and 92.4%, respectively. Among the 10 radiographic signs, all except maximal colon diameter were statistically significant predictors on the final diagnosis. Conclusions PAR is an accurate and effective initial imaging modality for differentiating between SBO and SBI in an emergency setting, and most of the classic radiographic signs have a diagnostic value.
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Affiliation(s)
- SH Kim
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - KN Park
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - J Kim
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - CK Eun
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - YM Park
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - MK Oh
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - KH Choi
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
- Uijeongbu St. Mary's Hospital, Department of Emergency Medicine, The Catholic University of Korea, 65-1 Geumo-dong, Uijeongbu-si, Gyeonggi-do, 480-717, Republic of Korea
| | - HJ Kim
- Uijeongbu St. Mary's Hospital, Department of Emergency Medicine, The Catholic University of Korea, 65-1 Geumo-dong, Uijeongbu-si, Gyeonggi-do, 480-717, Republic of Korea
| | - DW Kim
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - HJ Choo
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - JH Cho
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - JH Oh
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - HY Park
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
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Abdelwahed Y, Saber R, Imen BI, Hakim Z, Ayoub Z. A case report of small bowel obstruction secondary to congenital peritoneal band in adult. Int J Surg Case Rep 2016; 30:23-25. [PMID: 27898351 PMCID: PMC5128824 DOI: 10.1016/j.ijscr.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 11/18/2022] Open
Abstract
A case of small bowel obstruction due to peritoneal congenital band is presented. Computed tomography is effective for diagnosis. The laparoscopic approach for surgical treatment should be intended initially for its feasibility and benefits. A quick management is necessary to avoid intestinal necrosis. Introduction Small bowel obstruction (SBO) is common in adult surgical procedures, mainly due to postoperative adhesions. Acute SBO in adults without history of abdominal surgery, trauma or clinical hernia is less common and has various etiologies. Congenital band is an extremely rare cause. Presentation of case A 56-year-old man was admitted to our hospital with a two-day history of abdominal pain and bilious vomiting. He had no history of abdominal surgery or any other medical problems. A contrast-enhanced CT of the abdomen showed a distention of small bowel loops with transition point in the right hypochondrium. Distended loops of small bowel were located in the left side of the abdomen, whereas collapsed loops was located in the right side. The normal bowel wall enhancement was preserved. After initial treatment with intravenous fluid and nasogastric suction, he was operated. At laparoscopy a band obstructing the ileum was clearly observed. This anomalous band extending from gallbladder to transverse mesocolon caused a small window leading to internal herniation of the small bowel and obstruction. The band was coagulated and divided. Postoperative outcome was uneventful and the patient was discharged on the second postoperative day. There was no recurrence of symptoms on subsequent follow-up. Discussion Congenital peritoneal bands are not frequently encountered in surgical practice and these bands are often difficult to classify and define. Diagnosis of acute intestinal obstruction due to CPB must be included in the differential diagnosis in any patient with no history of abdominal surgery, trauma, clinical hernia, inflammatory bowel disease or peritoneal tuberculosis. Conclusion Despite technological advances in radiology preoperative diagnosis remains difficult, however the diagnosis of SBO due to CPB must be considered in any patient with no history of abdominal surgery, Trauma or clinical hernia consulting for occlusive syndrome. The laparoscopic approach should be intended initially for its feasibility and benefits.
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Affiliation(s)
- Yahmadi Abdelwahed
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Rebii Saber
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Ben Ismail Imen
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Zenaidi Hakim
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Zoghlami Ayoub
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia
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Makar RA, Bashir MR, Haystead CM, Iseman C, Mayes N, Hebert S, Allen BC, Bhattacharya SD, Choudhury KR, Jaffe TA. Diagnostic performance of MDCT in identifying closed loop small bowel obstruction. Abdom Radiol (NY) 2016; 41:1253-60. [PMID: 26830421 DOI: 10.1007/s00261-016-0656-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the diagnostic performance of MDCT in the diagnosis of closed loop small bowel obstruction. MATERIALS AND METHODS One hundred fifty patients with CT reports including "small bowel obstruction (SBO)" between 1/30/2011 and 12/4/2012 were included (65 men, 85 women, mean age 63 years). CT examinations were independently and blindly reviewed by five radiologists to determine the presence of closed loop obstruction (CL-SBO) and to assess findings of bowel ischemia. Clinical records were reviewed to determine management and operative findings. Using operative findings as a gold standard, reader agreement for the diagnosis of and the CT findings associated with CLO was analyzed using Pearson's correlation (r). Positive predictive value (PPV) and negative predictive value for the diagnosis of CL-SBO and CT signs of bowel ischemia were analyzed. RESULTS Eighty-eight of 150 patients underwent operative intervention for SBO and 24/88 were considered CL-SBO operatively. Average reader sensitivity and specificity for CL-SBO was 53 % (95 % CI 44-63 %) and 83 % (95 % CI 79-87 %). Reader agreement on CL-SBO was poor to moderate (K = 0.39-0.63). Reader agreement for CT signs of bowel ischemia resulting in a diagnosis of CL-SBO was weak (r = 0.19-0.32). CONCLUSION The CT diagnosis of CL-SBO is complex and associated imaging findings have variable sensitivity for predicting a closed loop operative diagnosis. CT can be helpful in excluding a closed loop component in patients with SBO.
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Drost WT, Green EM, Zekas LJ, Aarnes TK, Su L, Habing GG. COMPARISON OF COMPUTED TOMOGRAPHY AND ABDOMINAL RADIOGRAPHY FOR DETECTION OF CANINE MECHANICAL INTESTINAL OBSTRUCTION. Vet Radiol Ultrasound 2016; 57:366-75. [PMID: 27038072 DOI: 10.1111/vru.12353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/10/2015] [Accepted: 12/17/2015] [Indexed: 01/01/2023] Open
Abstract
Vomiting, often caused by mechanical intestinal obstruction, is common in dogs. Equivocal radiographic signs often necessitate repeat radiographs or additional imaging procedures. For our prospective, case-controlled, accuracy study, we hypothesized the following: (1) using computed tomography (CT), radiologists will be more sensitive and specific for detecting mechanical intestinal obstruction and recommending surgery compared to using radiographs; and (2) using measurements, radiologists will be more sensitive and specific using radiographs or CT for detecting mechanical intestinal obstruction and recommending surgery. Twenty dogs had abdominal radiographs and abdominal CT. Seventeen dogs had abdominal surgery and three dogs were not obstructed based on clinical follow-up. Confidence levels (five-point scale) of three experienced radiologists for mechanical intestinal obstruction and recommending surgery were recorded before and after making selected measurements. Eight dogs had surgically confirmed mechanical intestinal obstruction, and 12 dogs did not have obstruction. For detecting mechanical intestinal obstruction, CT was more sensitive (95.8% vs. 79.2%) and specific (80.6% vs. 69.4%) compared to radiographs, but the difference was not statistically significant. For recommending surgery, radiography was more sensitive (91.7% vs. 83.3%) and specific (83.3% vs. 72.2%) than using CT, but differences were not statistically significant. We reported objective CT measurements for predicting small mechanical intestinal obstruction. By incorporating these objective data, the diagnosis of mechanical intestinal obstruction changed in five of 120 instances (radiographs and CT). In no instance (0/120), did the objective data change the recommendation for surgery. Using CT or abdominal radiographs for the detection of canine mechanical intestinal obstruction is sensitive and specific when evaluated by experienced veterinary radiologists.
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Affiliation(s)
- Wm Tod Drost
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp, St. Columbus, OH, 43210
| | - Eric M Green
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp, St. Columbus, OH, 43210
| | - Lisa J Zekas
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp, St. Columbus, OH, 43210
| | - Turi K Aarnes
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp, St. Columbus, OH, 43210
| | - Lillian Su
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp, St. Columbus, OH, 43210
| | - Gregory G Habing
- Department of Preventive Veterinary Medicine, The Ohio State University, 601 Vernon Tharp, St. Columbus, OH, 43210
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Paulson EK, Thompson WM. Review of small-bowel obstruction: the diagnosis and when to worry. Radiology 2015; 275:332-42. [PMID: 25906301 DOI: 10.1148/radiol.15131519] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is a review of small-bowel obstruction written primarily for residents. The review focuses on radiography and computed tomography (CT) for diagnosing small-bowel obstruction and CT for determining complications. (©) RSNA, 2015.
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Affiliation(s)
- Erik K Paulson
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.K.P.); and Department of Radiology, University of New Mexico and New Mexico VA Health Care System, 1501 San Pedro Dr SE, Albuquerque, NM 87108-5128 (W.M.T.)
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13
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Mcmenamin D, Pearce A, Klassen M. Visual search in abdominopelvic CT interpretation: accuracy and time efficiency between coronal MPR and axial images. Acad Radiol 2015; 22:164-8. [PMID: 25442796 DOI: 10.1016/j.acra.2014.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to compare reader accuracy and time efficiency between coronal reformats of abdominopelvic computed tomography (CT) and axial images, by means of a visual search task. MATERIALS AND METHODS In this experimental crossover study, a novel visual search task, containing targets placed on actual CT images, was constructed to assess reader performance on both planes. Six trials were shown to participants in each plane, at a fixed time of 0.5 seconds per slice. The task was presented to 43 junior doctors. On each trial, participants were assessed for accuracy and confidence in finding the target on a five-point scale. Statistical analysis was performed using the Wilcoxon signed rank test, and Fleiss kappa. RESULTS Coronal images took 40% less time to view overall. No significant difference was found in reader accuracy or reader confidence between the two planes. Interrater agreement was observed as fair, across a very large number of raters (43). CONCLUSIONS Target identification in the coronal plane is extremely similar to the axial plane on abdominopelvic CT in this study and offers a substantial time benefit. A perceptual limit to visual processing of CT images may contribute to this similarity. Greater use of coronal reformats in day-to-day practice could substantially improve radiologist workflow.
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Affiliation(s)
- Drew Mcmenamin
- Lightbox Radiology Education, Noosaville, Queensland, Australia
| | - Alex Pearce
- The Queen Elizabeth Hospital, Woodville Rd, Woodville South, Adelaide, South Australia, Australia 5011.
| | - Matthew Klassen
- Lightbox Radiology Education, Noosaville, Queensland, Australia
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Pothiawala S, Gogna A. Early diagnosis of bowel obstruction and strangulation by computed tomography in emergency department. World J Emerg Med 2014; 3:227-31. [PMID: 25215068 DOI: 10.5847/wjem.j.issn.1920-8642.2012.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 04/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Closed loop bowel obstruction is a specific type of mechanical obstruction with a high risk of strangulation and bowel infarction, especially in the small bowel. It is associated with a high mortality rate. Hence, it is important for emergency physicians to identify the presence of strangulation, while making the diagnosis of closed loop small bowel obstruction. METHODS We reported three patients with strangulated closed loop small bowel obstruction associated with severe abdominal pain, who had been treated at the emergency department. Urgent computerized tomography was performed in the patients. RESULTS Two patients were discharged with stable conditions, and one patient died after hemodialysis. CONCLUSION Urgent computerized tomography of the abdomen serves as an important diagnostic tool in view of its ability to detect the site, level and cause of obstruction along with the distinctive CT appearance of closed loop small bowel obstruction and signs of ischemia. Early definitive diagnosis will guide subsequent management and improve outcomes.
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Affiliation(s)
- Sohil Pothiawala
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Apoorva Gogna
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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Accuracy of 64-slice multidetector computed tomography scan in detection of the point of transition of small bowel obstruction. Jpn J Radiol 2011; 30:235-41. [DOI: 10.1007/s11604-011-0038-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/24/2011] [Indexed: 12/31/2022]
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Juan YH, Yu CY, Hsu HH, Huang GS, Chan DC, Liu CH, Tung HJ, Chang WC. Using multidetector-row CT for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction. Yonsei Med J 2011; 52:574-80. [PMID: 21623598 PMCID: PMC3104453 DOI: 10.3349/ymj.2011.52.4.574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions. MATERIALS AND METHODS From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple's operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy. RESULTS The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT. CONCLUSION Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.
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Affiliation(s)
- Yu-Hsiu Juan
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
- Department of Radiology, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Chih-Yung Yu
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - De-Chuan Chan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Chang-Hsien Liu
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ho-Jui Tung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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Are multiplanar reconstructions necessary in routine body computed tomography practice?: what is the published evidence? J Comput Assist Tomogr 2010; 34:689-98. [PMID: 20861771 DOI: 10.1097/rct.0b013e3181e5ce78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE During computed tomography interpretation, some anatomical regions are optimally displayed in planes other than axial. The purpose of this review was to define best interpretative practice, by demonstrating through literature review and case demonstration the computed tomography applications that should routinely include multiplanar viewing of the volume. CONCLUSIONS Owing to multidetector-row computed tomography technology, multiplanar reconstructions not only have become realistic and reliable but also, in some clinical settings, have been shown to improve diagnostic accuracy and interpretation speed.
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Abstract
Conventional radiologic and endoscopic evaluations of the small bowel are often limited by the length, caliber, and motility of the small bowel loops. The development of new multidetector-row CT scanners, with faster scan times and isotropic spatial resolution, allows high-resolution multiphasic and multiplanar assessment of the bowel, bowel wall, and lumen. CT Enterography (CTE) is a variant of routine abdominal scanning, geared toward more sustained bowel filling with oral contrast material, and the use of multiplanar images, that can enhance gastrointestinal (GI) tract imaging. This article examines the techniques and clinical applications of CTE in comparison with CT enteroclysis, focusing on Crohn disease, obscure GI bleeding, GI tumors, acute abdominal pain, and bowel obstruction.
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Affiliation(s)
- Giulia A Zamboni
- Istituto di Radiologia, Policlinico GB Rossi, P.le L.A. Scuro 10, 37134 Verona, Italy.
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Taxonomy and imaging spectrum of small bowel obstruction after Roux-en-Y gastric bypass surgery. AJR Am J Roentgenol 2010; 194:120-8. [PMID: 20028913 DOI: 10.2214/ajr.09.2840] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE For most patients with morbid obesity, bariatric surgery is the only effective method to achieve sustainable weight loss. Small bowel obstruction (SBO) after bariatric surgery is a major complication that affects postoperative course and management. Knowledge of the types of and imaging findings for SBO is essential to prompt diagnosis. CONCLUSION We discuss different types of SBO and a taxonomic schemata of bowel obstruction (ABC classification) and present a review of imaging findings that facilitates optimal patient management.
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Clinical Utility of Multiplanar Reformation in Pulmonary CT Angiography. AJR Am J Roentgenol 2010; 194:70-5. [DOI: 10.2214/ajr.09.2380] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Stoker J, van Randen A, Laméris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology 2009; 253:31-46. [PMID: 19789254 DOI: 10.1148/radiol.2531090302] [Citation(s) in RCA: 217] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED Acute abdominal pain may be caused by a myriad of diagnoses, including acute appendicitis, diverticulitis, and cholecystitis. Imaging plays an important role in the treatment management of patients because clinical evaluation results can be inaccurate. Performing computed tomography (CT) is most important because it facilitates an accurate and reproducible diagnosis in urgent conditions. Also, CT findings have been demonstrated to have a marked effect on the management of acute abdominal pain. The cost-effectiveness of CT in the setting of acute appendicitis was studied, and CT proved to be cost-effective. CT can therefore be considered the primary technique for the diagnosis of acute abdominal pain, except in patients clinically suspected of having acute cholecystitis. In these patients, ultrasonography (US) is the primary imaging technique of choice. When costs and ionizing radiation exposure are primary concerns, a possible strategy is to perform US as the initial technique in all patients with acute abdominal pain, with CT performed in all cases of nondiagnostic US. The use of conventional radiography has been surpassed; this examination has only a possible role in the setting of bowel obstruction. However, CT is more accurate and more informative in this setting as well. In cases of bowel perforation, CT is the most sensitive technique for depicting free intraperitoneal air and is valuable for determining the cause of the perforation. Imaging is less useful in cases of bowel ischemia, although some CT signs are highly specific. Magnetic resonance (MR) imaging is a promising alternative to CT in the evaluation of acute abdominal pain and does not involve the use of ionizing radiation exposure. However, data on the use of MR imaging for this indication are still sparse. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/content/253/1/31/suppl/DC1.
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Affiliation(s)
- Jaap Stoker
- Departments of Radiology and Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands.
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Abstract
CT enterography is a new imaging modality that has distinct advantages over conventional CT, wireless capsule endoscopy, and barium examination. CT enterography is noninvasive and allows rapid mapping of disease activity before endoscopy and in cases where the endoscope cannot reach the diseased segment. CT enterography is readily available, is operator independent, and allows evaluation of extraenteric complications of small bowel disease. This article describes the latest techniques and applications of CT enterography.
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Location of the transition zone in CT of small-bowel obstruction: added value of multiplanar reformations. ACTA ACUST UNITED AC 2009; 34:35-41. [PMID: 18172705 DOI: 10.1007/s00261-007-9348-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess the additional value of multiplanar reformations (MPR) in comparison with axial images alone for location of the transition zone in CT of mechanical small-bowel obstruction (SBO). MATERIALS AND METHODS Sixty-nine consecutive patients with mechanical SBO underwent 16-slice multi detector row CT (MDCT). The gold standard for the precise location of the transition zone was established by two experienced abdominal radiologists, unblinded to clinical and surgical reports, reviewing all CT examinations. On a workstation, two blinded readers independently located the transition zone using first axial slices alone and then 1 month later MPR (axial, coronal, sagittal and oblique views) according to a three-point confidence scale. Diagnostic accuracy and mean confidence score were evaluated for both the transverse and multiplanar data sets. RESULTS Accuracy of transition zone location for reader 1 and reader 2 was 86% and 84% with axial slices alone, and by using MPR 93% (significant: P = 0.03) and 90% (not significant: P = 0.08), respectively. Mean confidence score was significantly increased for both readers using MPR: 0.3 higher (P = 0.0001) and 0.37 higher (P = 0.0001) respectively. CONCLUSION MPR can increase both accuracy and confidence in the location of the transition zone in CT of SBO.
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