Small bowel faeces sign in patients without small bowel obstruction

Area of Science:

• Radiology
• Gastroenterology
• Abdominal Imaging

Background:

• The 'small bowel faeces' sign (SBFS) is a computed tomography (CT) finding.
• Its frequency and clinical relevance in differentiating small bowel obstruction (SBO) from other causes of acute abdominal pain require evaluation.

Purpose of the Study:

• To assess the occurrence and clinical significance of the SBFS on CT scans.
• To compare the presence and characteristics of SBFS in patients with and without SBO who present with acute abdominal or flank pain.

Main Methods:

• Retrospective review of 1642 abdominal CT scans from patients with acute abdominal or flank pain.
• Independent assessment for SBFS by six radiologists, with consensus review for positive cases.
• Correlation of imaging findings with final diagnoses and comparison between SBO and non-SBO groups.

Main Results:

• A positive SBFS was identified in 6% of studies (100/1642).
• Of these, 32% (32/100) had SBO, while 68% (68/100) had other diagnoses.
• SBFS was more common in patients without SBO (p<0.273), but moderate/severe small bowel dilatation and distal collapse were highly indicative of SBO when SBFS was present (p<0.0001).

Conclusions:

• The SBFS is frequently observed in patients with acute abdominal pain but without bowel obstruction.
• When SBFS is accompanied by moderate or severe small bowel dilatation, it is significantly associated with SBO.
• The absence of significant small bowel dilatation alongside SBFS suggests a non-obstructive cause.