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[Post-operative small bowel obstruction: spiral computed tomography].

E Vibert1, J M Regimbeau, Y Panis

  • 1Service de chirurgie hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.

Annales De Chirurgie
|January 23, 2003
PubMed
Summary

Routine spiral computed tomography (SCT) may increase unnecessary early surgeries for small bowel obstruction (SBO). Further evaluation is needed to determine the systematic use of SCT in SBO diagnosis.

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Area of Science:

  • Medical Imaging
  • Surgical Gastroenterology
  • Diagnostic Radiology

Background:

  • Postoperative small bowel obstruction (SBO) management traditionally relies on clinical assessment.
  • The role of advanced imaging, like spiral computed tomography (SCT), in guiding SBO treatment is under investigation.

Purpose of the Study:

  • To prospectively assess the impact of routine abdominal SCT on the management of postoperative SBO.
  • To compare outcomes between patients managed with standard assessment versus those including SCT.

Main Methods:

  • A comparative study of two patient groups: pre-SCT (1989-1998, n=127) and SCT (1999-2000, n=30).
  • Management decisions were correlated with laparotomy findings: closed-loop obstruction, intestinal necrosis, or diffuse adhesions.
  • Clinical-biological-radiological assessment (CBRA) was compared with CBRA plus SCT (TDM).

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Main Results:

  • The SCT group showed a higher rate of surgery for diffuse adhesions (43% vs. 10%, p<0.01).
  • No intestinal necrosis was observed in the SCT group, unlike the pre-SCT group (0% vs. 17%).
  • The negative predictive value of CBRA plus SCT was significantly higher than CBRA alone (p=0.041).

Conclusions:

  • High sensitivity of SCT may lead to increased, potentially unnecessary, early laparotomies for non-necrotic closed-loop obstructions.
  • The routine, systematic use of SCT for suspected SBO requires further clinical evaluation to optimize patient management.