Correlation of CT findings with intra-operative outcome in closed-loop small bowel obstruction (CL-SBO).

Autor: de Kok BM; Department of Radiology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, the Netherlands. Electronic address: bentedekok@hotmail.com., Toneman MK; Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, the Netherlands., Oei S; Department of Radiology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, the Netherlands. Electronic address: s.oei@haaglandenmc.nl., Westerterp M; Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, the Netherlands. Electronic address: m.westerterp@haaglandenmc.nl., van Acker GJD; Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, the Netherlands. Electronic address: gijs.van.acker@haaglandenmc.nl., van der Pool AEM; Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, the Netherlands., Zijta FM; Department of Radiology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA The Hague, the Netherlands., Bipat S; Clinical Epidemiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Electronic address: s.bipat@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: European journal of radiology [Eur J Radiol] 2021 Sep; Vol. 142, pp. 109844. Date of Electronic Publication: 2021 Jul 06.
DOI: 10.1016/j.ejrad.2021.109844
Abstrakt: Purpose: To correlate CT-findings in patients with closed-loop small bowel obstruction (CL-SBO) with perioperative findings, to identify patients who require immediate surgical intervention. Secondary purpose was to substantiate the role of radiologists in predicting perioperative outcome.
Methods: Data were retrospectively obtained from patients with surgically confirmed CL-SBO, between September 2013 and September 2019. Three radiologists reviewed CTs to assess defined CT features and predict patient outcome for bowel wall ischemia and necrosis using a likelihood score. Univariate statistical analyses were performed and diagnostic performance parameters and interobserver agreement were assessed for each feature.
Results: Of 148 included patients, 28 (19%) intraoperatively had viable bowel and 120 (81%) had bowel wall ischemia or necrosis. Most CT characteristics, as well as the likelihood of ischemia and necrosis, found fair or moderate multirater agreement. Increased attenuation of bowel wall and mesenteric vessels on non-contrast-enhanced CT had a specificity for bowel ischemia or necrosis of 100% (sensitivity respectively 48% (p < 0.001) and 21% (p = 0.09)). Mesenteric edema had high sensitivity for ischemia or necrosis (90%), but specificity of only 26% (p < 0.001). For mesenteric fluid, sensitivity was 60% and specificity 57% (p = 0.004). Decreased enhancement of bowel wall in both arterial and PV-phase showed significant correlation, respectively a sensitivity of 58% and 42%, and specificity of 88% and 79% (both p < 0.001). Likelihood of both ischemia and necrosis were significantly correlated with perioperative outcome (p < 0.001).
Conclusion: CT findings concerning mesenteric and bowel wall changes, as well as radiologists' judgement of likelihood of ischemia and necrosis are significantly correlated with perioperative outcome of bowel wall ischemia and necrosis in patients with CL-SBO.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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