CT value of the intestine is useful predictor for differentiate irreversible ischaemic changes in strangulated ileus

To determine the differential points of strangulated ileus with and without irreversible ischaemic changes, especially on preoperative computed tomography (CT) images.

Seventy patients with strangulated ileus underwent emergency operations between January 2009 and July 2016 in our department. Of these patients, 57 met the study requirements, including 30 patients who had irreversible ischaemic changes (ischaemic group; n = 30) and 27 patients who had reversible ischaemic changes during laparotomy (non-ischaemic group; n = 27). We compared the preoperative clinical and radiographic factors between the ischaemic and non-ischaemic groups.

Univariate analysis revealed that a mean CT value of the intestine in an unenhanced image ≥16.5 HU (p < 0.001), a mean CT value ratio of the intestine (enhanced/unenhanced image) <1.5 (p < 0.001), presence of mesenteric fluid (p = 0.002) and presence of free peritoneal fluid (p = 0.009) were associated with the ischaemic group.

Calculation of the mean CT value of a strangulated intestine may be a useful method for predicting irreversible ischaemic changes in addition to the presence of mesenteric fluid or free peritoneal fluid.