Role of CT scan in evaluation and management of intestinal obstruction

Authors

  • Gaurav Baid Department of Surgery, Sardar Patel Medical College and AGH, Bikaner, Rajasthan, India
  • Manohar Lal Dawan Department of Surgery, Sardar Patel Medical College and AGH, Bikaner, Rajasthan, India
  • Ashok Parmar Department of Surgery, Sardar Patel Medical College and AGH, Bikaner, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20172777

Keywords:

CT Scan, Extraluminal, Intestinal obstruction

Abstract

Background: Intestinal obstruction is one of the most common diseases in abdominal surgery. It can slowly lead to changes in intestinal structure and function, and in extreme cases it can be life-threatening. CT allows imaging of the abdominal contents outside the lumen, because of this advantage, the nature and site of the obstruction, especially extraluminal or intramural process, can be established.

Methods: Prospective Hospital Based study. From January 2016 to November 2016 (11 months). 50 Patients presenting to Department of Surgery, whether in OPD or Emergency, with complaints suggestive of intestinal obstruction with in study duration eligible as per inclusion criteria will be included in the study.

Results: In present study Majority (52.0%) of study population belonged to 41-60 years age group. The most common symptom was pain abdomen (94%). Majority (66%) patients showed multiple air fluid level on X-ray. In CT imaging, maximum 36% presented with dilated bowel loops. 86% were diagnosed as sub-acute intestinal obstruction, in USG. In present study, 60% patients were treated by surgery. Majority of patients (86.67%) CT findings matched with perop/ intraoperative findings. Accurate CT findings were helpful in guiding patient management. In our study, CT had the sensitivity of 86.67%, Specificity75%.

Conclusions: Management decisions in intestinal obstruction remain notoriously difficult, relying on a combination of clinical and imaging factors to help stratify patients into conservative or surgical treatment.

Author Biography

Gaurav Baid, Department of Surgery, Sardar Patel Medical College and AGH, Bikaner, Rajasthan, India

Resident Doctor,

Department of General Surgery,

Sardar Patel Medical College,

Bikaner, Rajasthan, India.

References

Mucha P. Small intestinal obstruction. Surg Clin North Am. 1987;67:597.

Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg. 2000;87:1240.

Wright HK, O'Brien JJ, Tilson MD. Water absorption in experimental closed segment obstruction of the ileum in man. Am J Surg. 1971;121:96.

Ray NF, Denton WG, Thamer M. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am CollSurg. 1998;186:1.

Scott FI, Osterman MT, Mahmoud NN, Lewis JD. Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988-2007. Am J Surg. 2012;204:315.

Drożdż W, Budzyński P. Change in mechanical bowel obstruction demographic and etiological patterns during the past century: observations from one health care institution. Arch Surg. 2012;147:175.

Butt MU, Velmahos GC, Zacharias N. Adhesional small bowel obstruction in the absence of previous operations: management and outcomes. World J Surg. 2009;33:2368.

Frager D, Medwin SW, Baer JW. CT of small bowel obstruction: value in establishing the diagnosis and determining the degree and cause. Am J Roentgenol. 1994;162:37-41.

Gazekke GS, Goldberg MA, Wittenberg J, Halpern EF. Efficacy of CT in distinguishing small bowel obstruction from other causes of small bowel dilatation. Am J Roentgenol. 1994;162:43-7.

Mallo RD, Salem R, Lalani T. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastro -intest Surg. 2005;9:690-4.

Randen A, Lamérisa W, Luitse JSK. The role of plain radiographs in patients with acute abdominal pain at the ED. Am J Emerg Med. 2011;29:582-9.e2.

Achiek MM, Tawad FK, Ladu JD. Where there is no CT scan plain abdominal X-ray suffices to diagnose and manage bowel obstruction. Sudan Med J. 2016;52(1).

Donckier V, Closset J, Van Gansbeke D, Zalcman M, Sy M, Houben JJ, et al. Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction. Br J Surg. 1998;85(8):1071-4.

Saini DK, Chaudhary P, Durga C. Role of multislice computed tomography in evaluation and management of intestinal obstruction. Clin Pract. 2013;3(2):e20.

Mallo RD, Salem L, Lalani T, Flum DR. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg. 2005;9(5):690-4.

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Published

2017-06-22

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Original Research Articles