Khyber Medical University Journal (Mar 2024)
Diagnostic accuracy of computed tomography scan against surgical findings in small bowel obstruction cases
Abstract
OBJECTIVE: To determine the diagnostic accuracy of computed tomography (CT) scan in small bowel obstruction, (SBO), utilizing operative findings as the gold standard. METHODS: This descriptive cross-sectional study was conducted at Dr. Ruth K.M. Pfau Civil Hospital Karachi, Pakistan from September 2019 to August 2020. A comprehensive assessment, including plain and contrast-enhanced CT scans of the abdomen, was performed on 267 patients with clinically suspected acute SBO. Operative findings were compared with CT results to determine diagnostic accuracy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were evaluated, considering operative findings as the gold standard. RESULTS: Out of 267 patients, 162 (60.7%) were males, and 105 (39.3%) were females, with a mean age of 33.03±10.58 years. The mean duration of symptoms was 12.11±4.13 days. Overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the CT scan were 92.2%, 87.8%, 87.4%, 92.4%, and 89.9%, respectively. Common CT findings included dilated small bowel loops (128 cases, 100%), the point of transition (105 cases, 82%), and bowel wall thickening (71 cases, 55.5%). Post-operative analysis revealed 118 out of 128 confirmed cases and 17 additional cases initially missed by CT. Tuberculosis emerged as the leading histopathological cause (25.9%), followed by obstructed/strangulated hernias (22.2%) and adhesions (17.7%). CONCLUSION: This study emphasizes the superior diagnostic precision of CT scans in determining the level and cause of SBO, reflecting a high sensitivity (92.2%) and specificity (87.8%). Common CT findings, including dilated bowel loops, contribute to precise identification, guiding effective clinical management.
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