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[Early operation in radiologically negative adhesion ileus]
G Fankhauser1, R Meyrat, A Schnetzer
1Chirurgische Klinik, Bürgerspital Solothurn.
Helvetica Chirurgica Acta
|May 1, 1992
Summary
Radiographs for mechanical ileus can be misleading. Negative X-ray findings do not rule out obstruction, and may indicate a higher risk of strangulation, necessitating prompt surgical evaluation based on clinical signs.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Mechanical ileus secondary to adhesive bands is a common surgical emergency.
- Abdominal radiography is a standard initial diagnostic tool.
- Interpreting radiographic findings in suspected ileus can be challenging.
Purpose of the Study:
- To evaluate the diagnostic accuracy of abdominal X-rays in mechanical ileus.
- To assess the impact of negative radiographic findings on surgical outcomes.
- To determine optimal management strategies for patients with suspected ileus and non-diagnostic imaging.
Main Methods:
- Retrospective analysis of 46 patients undergoing laparotomy for adhesive band-induced mechanical ileus.
- Review of supine and upright abdominal X-ray films.
- Comparison of outcomes based on initial radiographic findings (positive vs. negative).
Main Results:
- 32.8% of patients had negative initial X-ray findings (no air-fluid levels or distention).
- Patients with negative X-rays had a significantly higher rate of strangulation ileus (p=0.004).
- Delayed surgery in patients with negative X-rays led to higher resection rates (50% vs. 25%) and longer symptom duration.
Conclusions:
- Negative abdominal radiographs cannot exclude mechanical ileus.
- Clinical presentation is crucial, especially when X-rays are non-diagnostic.
- Prompt surgical intervention is recommended for suspected strangulation ileus, even with negative imaging, to prevent intestinal necrosis.