TY - JOUR
T1 - Correlation of CT findings with intra-operative outcome in closed-loop small bowel obstruction (CL-SBO)
AU - de Kok, Bente M.
AU - Toneman, Masja K.
AU - Oei, Stanley
AU - Westerterp, Marinke
AU - van Acker, Gijs J. D.
AU - van der Pool, Anne E. M.
AU - Zijta, Frank M.
AU - Bipat, Shandra
N1 - Funding Information: We would like to express our great appreciation to Julien B.C.M. Puylaert and Robin H.M. Smithuis for the idea of this manuscript and for their efforts in educating radiologists and other relevant medical personnel in the Netherlands on acute abdominal imaging in general and on CL-SBO in particular. Publisher Copyright: © 2021 Elsevier B.V. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - 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.
AB - 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.
KW - Bowel ischemia
KW - Closed loop small bowel obstruction
KW - Computed tomography
KW - Intestinal obstruction
KW - Small intestine
UR - http://www.scopus.com/inward/record.url?scp=85110219413&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejrad.2021.109844
DO - https://doi.org/10.1016/j.ejrad.2021.109844
M3 - Article
C2 - 34252868
SN - 0720-048X
VL - 142
JO - European Journal of Radiology
JF - European Journal of Radiology
M1 - 109844
ER -