Al-Azhar Assiut Medical Journal (Jan 2019)
Role of computerized tomography in the management of intestinal obstruction in adults
Abstract
Background Computed tomography (CT) has become the most important noninvasive imaging tool to diagnose small and large bowel diseases as it has the potential to provide significant information that leads to timely appropriate treatment and thus positively affect the outcome, morbidity, and mortality of patients. Patients and methods Fifty five adult patients who presented with clinical manifestations of intestinal obstruction were registered in the study. CT findings were based on dilated bowel, complete obstruction, partial obstruction, transition point, ascites, closed loop, free air, and other factors as and when required. Patients who had features suggestive of complete or complicated obstruction (strangulation, ischemia) were taken up for surgery on an emergency basis. Patients who showed improvement on conservative management and clinicoradiological features suggestive of uncomplicated partial obstruction were kept on conservative management. Results Complete obstruction was seen in 44% of patients (22 cases) and all of them underwent surgery. Partial obstruction was seen in 56% (28 cases), of which 71.4% (20 cases) were operated upon. Postoperative adhesions were the most common etiology in the study group (26%). Out of 42 patients who were treated by surgery, majority of patients (88%) matched with preoperative CT findings, whereas in 12% of patients, CT findings did not match with intraoperative findings. CT sensitivity was 76.6%, specificity was 75%, positive predictive value was 94.2%, negative predictive value was 40%, and accuracy was 78%. Conclusion Clinical sense still the mainstay for deciding the line of management in cases of intestinal obstruction. CT in this category of patients can help surgeons to perform surgery early and prevent complications. It also helps in preventing unnecessary surgeries in patient who can be treated conservatively.
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