Diagnostic Utility of CT Findings as Indicators for Bowel Resection in Strangulated Small Bowel Obstruction

Background/objectives: Strangulated small bowel obstruction (SSBO) is a life-threatening condition that often requires emergency surgery. Identifying preoperative computed tomography (CT) findings indicative of bowel resection may improve diagnostic accuracy and inform surgical decision-making. Methods: We retrospectively analyzed patients diagnosed with SSBO who underwent contrast-enhanced abdominal CT and emergency surgery between January 2022 and April 2024. Patients were divided into two groups according to the surgical outcomes: those who underwent bowel resection and those who did not. CT images were independently reviewed by a radiologist blinded to surgical outcomes, and CT findings were compared between the resection and non-resection groups. Variables significant in the between-group comparisons (p < 0.05) were entered into a multivariable logistic regression to identify indicators for bowel resection. Results: Fifty-two patients were identified, sixteen (30.8%) of whom required bowel resection. The most reliable indicator was absent bowel wall enhancement on contrast-enhanced CT, with a sensitivity of 75.0% and specificity of 86.1%. It was also independently associated with bowel resection [odds ratio (OR) 19.7; 95% confidence interval: 3.43-113.4]. In contrast, ascites, beak sign, and mesenteric edema were commonly observed in both groups and lacked specificity. Of note, bowel resection was avoided in 5 of 17 patients with absent bowel wall enhancement based on intraoperative assessment using indocyanine green (ICG) fluorescence imaging. Conclusions: Absent bowel wall enhancement on contrast-enhanced CT is an independent preoperative indicator for bowel resection in SSBO.