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Strangulating Closed-Loop Obstruction: Sonographic Signs.

A Hollerweger1, S Rieger1, N Mayr1

  • 1Department of Radiology, KH Barmherzige Brüder, Salzburg, Austria.

Ultraschall in Der Medizin (Stuttgart, Germany : 1980)
|April 16, 2015
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Summary
This summary is machine-generated.

Key ultrasound findings for strangulating closed-loop obstruction include akinetic bowel loops, thickened mesentery, and free peritoneal fluid. Anechoic luminal content is a helpful, though not always present, diagnostic clue.

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Area of Science:

  • Gastroenterology
  • Radiology
  • Surgical Pathology

Background:

  • Strangulating closed-loop obstruction is a surgical emergency requiring prompt diagnosis.
  • Ultrasound (US) is a valuable imaging modality for evaluating acute abdominal conditions.
  • Identifying specific sonographic signs can aid in the early detection of strangulating intestinal obstruction.

Purpose of the Study:

  • To retrospectively evaluate various sonographic signs associated with strangulating closed-loop obstruction.
  • To determine the frequency and diagnostic significance of different ultrasound findings in this condition.

Main Methods:

  • A retrospective review of approximately 10 years of patient data, including ultrasound scans and video clips, was conducted.
  • Evaluated sonographic signs included akinetic bowel loops, anechoic luminal content, mesenteric changes, free peritoneal fluid, bowel wall thickening, and signs of ischemia.
  • Proximal bowel obstruction and the width of the strangulated segment were also assessed.

Main Results:

  • Akinetic bowel loops (94%), hyperechoic and thickened mesentery (82%), and free peritoneal fluid (100%) were the most frequent findings.
  • Anechoic luminal content was observed in 54% of cases.
  • Bowel wall thickening (76%) and signs of ischemia on Doppler or contrast-enhanced US (50%) were also noted. Proximal small bowel dilatation occurred in 67%.

Conclusions:

  • Akinetic bowel loops, thickened hyperechoic mesentery, and free peritoneal fluid are characteristic of strangulating closed-loop obstruction.
  • Anechoic luminal content, while present in about half the cases, can be a crucial diagnostic indicator.
  • Proximal signs of obstruction may be absent in about one-third of patients, and the strangulated loop may show mild or no dilatation.