Bowel obstruction CT: Difference between revisions
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==Overview== | ==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. | 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== | ==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> | *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 | **Dilated [[bowel]] loops with air-fluid level | ||
**Distal collapsed bowel | **Distal collapsed [[bowel]] | ||
***Additional signs: | ***Additional signs: | ||
****"Target sign" – indicates [[intussusception]] | ****"Target sign" – indicates [[intussusception]] | ||
****"Whirl sign" – indicates [[volvulus]] | ****"Whirl sign" – indicates [[volvulus]] | ||
****"Venous cut-off sign" - indicates [[thrombosis]] | ****"Venous cut-off sign" - indicates [[thrombosis]] | ||
****Ascites | ****[[Ascites]] | ||
****Edema of the mesentery and submucosal edema | ****[[Edema]] of the [[mesentery]] and [[submucosal]] [[edema]] | ||
****Hemorrhage | ****[[Hemorrhage]] | ||
****Bowel wall thickness exceeding 3mm | ****[[Bowel]] wall thickness exceeding 3mm | ||
===Advantages over | [[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 ]] | ||
*CT scan can determine the following over plain | |||
===Advantages over X-ray=== | |||
*[[CT scan]] can determine the following over plain [[X-ray]]: | |||
**Specific site of obstruction | **Specific site of obstruction | ||
**Severity of obstruction | **Severity of obstruction | ||
***Complete or partial | ***Complete or partial | ||
**Etiology | **[[Etiology]] | ||
***Such as a hernia or mass or inflammations | ***Such as a [[hernia]] or [[Mass (medicine)|mass]] or inflammations | ||
**Complications | **Complications | ||
***Such as ischemia, necrosis, and perforations | ***Such as [[ischemia]], [[necrosis]], and [[Perforation|perforations]] | ||
===Timing of CT scan=== | ===Timing of CT scan=== | ||
*It is recommended to perform an | *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. | *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=== | ===Sensitivity and specificity of CT scanning according to slice margin=== | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Emergency medicine]] | | ||
[[Category:Radiology]] | [[Category:Emergency medicine]] | ||
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Latest revision as of 16:03, 27 February 2018
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Bowel obstruction Microchapters |
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Bowel obstruction CT On the Web |
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American Roentgen Ray Society Images of Bowel obstruction CT |
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
- Additional signs:
Advantages over X-ray
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.