1
|
Pan S, Yang J, Liu Z, Nai R, Chen Z. A prediction model to differentiate transient ischemia from irreversible transmural necrosis in closed-loop small bowel obstruction. Front Med (Lausanne) 2024; 11:1466754. [PMID: 39323473 PMCID: PMC11422149 DOI: 10.3389/fmed.2024.1466754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024] Open
Abstract
Introduction The study aims to develop a prediction model to differentiate transient ischemia from irreversible transmural necrosis in closed-loop small bowel obstruction (CL-SBO). Methods A total of 180 participants with CL-SBO between January 2010 and December 2019, of which 122 had complete radiologic data, were included to investigate the significant clinical and imaging characteristics for differentiating patients with necrosis from transient ischemia. A logistic regression model was developed and validated. Results In a multivariate analysis, the American Society of Anesthesiologists physical status classification system >2 is the independent predictor for transmural necrosis. Another multivariate analysis, including clinical and imaging factors, revealed that the imaging sign of mesenteric vessel interruption was an independent risk factor for necrosis. The diagnostic model developed using these two factors has excellent performance among the validation sets, with an area under the curve of 0.89. Conclusion The diagnostic model and innovative imaging signs have substantial potential in solving this complex clinical problem.
Collapse
Affiliation(s)
- Shaorong Pan
- Department of Gastrointestinal Surgery, Peking University First Hospital, Peking University, Beijing, China
| | - Jiejin Yang
- Department of Radiology, Peking University First Hospital, Peking University, Beijing, China
| | - Zining Liu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rile Nai
- Department of Radiology, Peking University First Hospital, Peking University, Beijing, China
| | - Zeyang Chen
- Department of Gastrointestinal Surgery, Peking University First Hospital, Peking University, Beijing, China
| |
Collapse
|
2
|
Li BQ, Qi WJ, Yuan M, Wang HY, Chen M, Lei JA, Meng M, Li Q, Li L, Jiang B, Ma ZL, Xiu DR, Yuan CH. Prediction of bowel necrosis by reduced bowel wall enhancement in closed-loop small bowel obstruction: Quantitative methods. Eur J Radiol 2024; 173:111363. [PMID: 38367415 DOI: 10.1016/j.ejrad.2024.111363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE To assess diagnostic performance and reproducibility of reduced bowel wall enhancement evaluated by quantitative methods using CT to identify bowel necrosis among closed-loop small bowel obstruction (CL-SBO) patients. METHODS This retrospective single-center study included patients who diagnosed with CL-SBO caused by adhesion or internal hernia during January 2016 and May 2022. Patients were divided into necrotic group (n = 41) and non-necrotic group (n = 67) according to surgical exploration and postoperative pathology. Two doctors independently measured the attenuation of bowel wall and consensus was reached through panel discussion with a third gastrointestinal radiologist. Reduced bowel wall enhancement was assessed by four quantitative methods. Univariate analyses were used to evaluate the association between each method and bowel necrosis, and kappa/intraclass correlation coefficient values were used to assess interobserver agreement. Diagnostic performance parameters were calculated for each method. RESULTS Reduced bowel wall enhancement in arterial phase (OR 8.98, P < 0.0001), reduced bowel wall enhancement in portal phase (OR 16.84, P < 0.001), adjusted reduced bowel wall enhancement in arterial phase (OR 29.48, P < 0.001), adjusted reduced bowel wall enhancement in portal phase (OR 145.69, P < 0.001) were significantly associated with bowel necrosis. Adjusted reduced bowel wall enhancement in portal phase had the best diagnostic performance (AUC: 0.92; Youden index: 0.84; specificity: 94.03 %) and interobserver agreement (kappa value of 0.59-0.73) to predict bowel necrosis. CONCLUSION When assessing reduced bowel enhancement to predict bowel necrosis among CL-SBO patients, using unenhanced CT images and proximal dilated loop as standard references in portal phase is the most accurate quantitative method among those tested.
Collapse
Affiliation(s)
- Bing-Qi Li
- Department of General Surgery, Peking University Third Hospital, Beijing, China; Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China
| | - Wei-Jun Qi
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Meng Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Hang-Yan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Ming Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ji-An Lei
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Meng Meng
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Qi Li
- Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China
| | - Lei Li
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Bin Jiang
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Zhao-Lai Ma
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Dian-Rong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Chun-Hui Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
3
|
Li BQ, Qi WJ, Yuan M, Wang HY, Chen M, Song ZX, Li Q, Li L, Jiang B, Ma ZL, Xiu DR, Yuan CH. Increased Attenuation of Intestinal Contents at CT Indicates Bowel Necrosis in Closed-Loop Small Bowel Obstruction. Radiology 2024; 310:e231710. [PMID: 38319165 DOI: 10.1148/radiol.231710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Preoperative recognition of irreversible bowel necrosis is important, as it provides valuable guidance for surgical strategy selection but also may inform perioperative risk assessment and communication. Few studies have focused on the association between CT signs and bowel necrosis. Purpose To assess the diagnostic accuracy of CT signs to predict bowel necrosis in patients with closed-loop small bowel obstruction (CL-SBO). Materials and Methods This retrospective single-center study included patients who were surgically confirmed to have CL-SBO caused by adhesion or internal hernia between January 2016 and May 2022. Necrosis was determined based on surgical exploration and postoperative pathologic examination. Two radiologists independently reviewed CT signs by both subjective visual assessment and objective measurement. Disagreements were resolved in consensus with a third gastrointestinal radiologist. Univariable and multivariable analyses were used to assess the association between CT signs and bowel necrosis, and Cohen κ was used to assess interobserver agreement. Sensitivity and specificity were calculated for each CT sign. Results This study included 145 patients: 61 (42.1%) in the necrotic group (median age, 62 years [IQR, 51-71.5 years]; 37 [60.7%] women) and 84 (57.9%) in the nonnecrotic group (median age, 61.5 years [IQR, 51-68.8 years]; 51 [60.7%] women). Univariable analysis and multivariable analysis showed that increased attenuation of intestinal contents and increased attenuation of intestinal wall were independent predictors for bowel necrosis (odds ratio = 45.3 and 15.1; P = .001 and P < .001, respectively). Increased attenuation of intestinal contents and increased attenuation of intestinal wall had similar sensitivity (64% and 67%, respectively) and specificity (99% and 92%, respectively) for predicting bowel necrosis. However, interobserver agreement was better for assessing the contents than the wall (κ = 0.84 and 0.59, respectively). Conclusion Increased attenuation of intestinal contents was a highly specific CT sign with good reproducibility to predict bowel necrosis in CL-SBO. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Taourel and Zins in this issue.
Collapse
Affiliation(s)
- Bing-Qi Li
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Wei-Jun Qi
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Meng Yuan
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Hang-Yan Wang
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Ming Chen
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Zi-Xiu Song
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Qi Li
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Lei Li
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Bin Jiang
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Zhao-Lai Ma
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Dian-Rong Xiu
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Chun-Hui Yuan
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| |
Collapse
|
4
|
Taourel P, Zins M. Unenhanced CT for Predicting Bowel Necrosis in Small Bowel Obstruction: Time to Adapt Our Protocol. Radiology 2024; 310:e240001. [PMID: 38319167 DOI: 10.1148/radiol.240001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Patrice Taourel
- From the CHU Lapeyronie Montpellier, University of Montpellier 1, 371 avenue du Doyen Gaston Giraud, Montpellier 34295, France (P.T.); and Department of Radiology, Hôpital Paris Saint-Joseph, Paris, France (M.Z.)
| | - Marc Zins
- From the CHU Lapeyronie Montpellier, University of Montpellier 1, 371 avenue du Doyen Gaston Giraud, Montpellier 34295, France (P.T.); and Department of Radiology, Hôpital Paris Saint-Joseph, Paris, France (M.Z.)
| |
Collapse
|
5
|
Oh S, Ryu J, Shin HJ, Song JH, Son SY, Hur H, Han SU. Deep learning using computed tomography to identify high-risk patients for acute small bowel obstruction: development and validation of a prediction model : a retrospective cohort study. Int J Surg 2023; 109:4091-4100. [PMID: 37720936 PMCID: PMC10720875 DOI: 10.1097/js9.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/19/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To build a novel classifier using an optimized 3D-convolutional neural network for predicting high-grade small bowel obstruction (HGSBO). SUMMARY BACKGROUND DATA Acute SBO is one of the most common acute abdominal diseases requiring urgent surgery. While artificial intelligence and abdominal computed tomography (CT) have been used to determine surgical treatment, differentiating normal cases, HGSBO requiring emergency surgery, and low-grade SBO (LGSBO) or paralytic ileus is difficult. METHODS A deep learning classifier was used to predict high-risk acute SBO patients using CT images at a tertiary hospital. Images from three groups of subjects (normal, nonsurgical, and surgical) were extracted; the dataset used in the study included 578 cases from 250 normal subjects, with 209 HGSBO and 119 LGSBO patients; over 38 000 CT images were used. Data were analyzed from 1 June 2022 to 5 February 2023. The classification performance was assessed based on accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS After fivefold cross-validation, the WideResNet classifier using dual-branch architecture with depth retention pooling achieved an accuracy of 72.6%, an area under receiver operating characteristic of 0.90, a sensitivity of 72.6%, a specificity of 86.3%, a positive predictive value of 74.1%, and a negative predictive value of 86.6% on all the test sets. CONCLUSIONS These results show the satisfactory performance of the deep learning classifier in predicting HGSBO compared to the previous machine learning model. The novel 3D classifier with dual-branch architecture and depth retention pooling based on artificial intelligence algorithms could be a reliable screening and decision-support tool for high-risk patients with SBO.
Collapse
Affiliation(s)
- Seungmin Oh
- Department of Artificial Intelligence, Ajou University, Suwon, South Korea
| | - Jongbin Ryu
- Department of Artificial Intelligence, Ajou University, Suwon, South Korea
- Department of Software and Computer Engineering, Ajou University, Suwon, South Korea
| | - Ho-Jung Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jeong Ho Song
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| |
Collapse
|
6
|
Liu X, Zhu M, Wu M, Cheng Z, Wu X, Zhu R. Unenhanced CT-based predictive model to identify small bowel necrosis in patients with mechanical small bowel obstruction. BMC Med Imaging 2023; 23:80. [PMID: 37308879 DOI: 10.1186/s12880-023-01041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES To investigate the diagnostic value of unenhanced CT in mechanical small bowel obstruction (SBO) with small bowel necrosis, and to establish a predictive model. METHODS From May 2017 to December 2021, the patients with mechanical SBO admitted to our hospital were retrospectively collected. Taking pathology-confirmed small bowel necrosis as the gold standard, the experimental group was composed of patients with small bowel necrosis confirmed by pathology, and the control group was composed of patients with no intestinal necrosis confirmed by surgery or successful conservative treatment with no recurrence of intestinal obstruction during 1-month followed-up. RESULTS A total of 182 patients were enrolled in this study, 157 patients underwent surgery, of which 35 patients were accompanied with small bowel necrosis and 122 patients were not (33 patients with ischemic findings at surgery without necrosis). Finally, there were 35 patients in the experimental group and 147 patients in the control group. Multivariable logistic regression showed that increased attenuation of small bowel wall (P = 0.002), diffuse mesenteric haziness (P = 0.010), difference of CT value between mesenteric vessel and aorta (P = 0.025) and U-/C-shaped small bowel loop (P = 0.010) were independent risk factors for the diagnosis of mechanical SBO with small bowel necrosis. Through internal verification, the area under curve (AUC) of the predictive model reached 0.886 (95%CI: 0.824-0.947), and the calibration result was moderate. CONCLUSION Multiple features (increased attenuation of small bowel wall; difference of CT values between mesenteric vessel and aorta; diffuse mesenteric haziness; and U-/C-shaped small bowel loop) of unenhanced CT have clinical value in the diagnosis of mechanical SBO with small bowel necrosis. The predictive model based on these four features could achieve satisfactory efficiency.
Collapse
Affiliation(s)
- Xianwei Liu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China.
| | - MingJie Zhu
- Department of Gastrointestinal Surgery, The People's Hospital of Leshan, Sichuan province, Leshan, China
| | - Ming Wu
- Department of Image Center, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, China
| | - Zhangsong Cheng
- Department of Image Center, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, China
| | - Xiaoyu Wu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China
| | - Renfang Zhu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China
| |
Collapse
|
7
|
Kim HR, Lee Y, Kim J, Baek TW, Kim H, Son JH, Park EJ, Kim SH. Closed loop obstruction of small bowel: CT signs predicting successful non-surgical treatment. Eur J Radiol 2023; 161:110716. [PMID: 36758277 DOI: 10.1016/j.ejrad.2023.110716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/04/2022] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To clarify the computed tomography (CT) findings related to successful conservative treatments in patients with closed-loop small bowel obstruction (CL-SBO) without evidence of bowel strangulation. METHODS Sixty-four patients (71 CT scans) diagnosed with CL-SBO by CT and received initial conservative treatments from May 2010 to August 2020 were retrospectively included. Two blinded radiologists reviewed the CT findings, including the transition zone (number, distance, and location), maximum bowel diameter, mesenteric haziness, mesenteric fluid, increased unenhanced bowel wall attenuation, decreased bowel wall enhancement, small bowel feces sign, whirl sign, bowel wall thickening, ascites, and degree of obstruction. The findings of the success and failure groups of conservative treatment were compared. Interobserver agreement was assessed for all findings. RESULTS Among the 71 cases, conservative treatments were successful in 42 cases (59 %) but failed in 29 cases (41 %). In multivariable analyses, the distance between the transition zones (>1 cm) and low-degree obstruction were independently associated with successful conservative treatments, with odds ratios of 6.23 and 3.52, respectively. The combination of these two CT findings exhibited a specificity of 89.7 % with a positive likelihood ratio of 3.01. Interobserver agreement of the degree of obstruction and the distance between the transition zones was almost perfect (ĸ = 0.814 and 0.914, respectively). CONCLUSIONS The distance between the transition zones (>1 cm) and low-grade obstruction are independent CT predictors of successful conservative treatments in CL-SBO patients. Initial conservative treatments are recommended for patients with both CT findings.
Collapse
Affiliation(s)
- Hye Ri Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Yedaun Lee
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea.
| | - Jieun Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Tae Wook Baek
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Hyunwoong Kim
- Clinical Trial Center, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Jung Hee Son
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Eun Joo Park
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| |
Collapse
|
8
|
Gómez Corral J, Niño Rojo C, de la Fuente Olmos R. Bowel obstruction: signs indicating the need for urgent surgery. RADIOLOGIA 2023; 65 Suppl 1:S92-S98. [PMID: 37024235 DOI: 10.1016/j.rxeng.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/11/2022] [Indexed: 04/08/2023]
Abstract
Bowel obstruction is common in emergency departments. Obstruction is more common in the small bowel than in the large bowel. The most common cause is postsurgical adhesions. Nowadays, bowel obstruction is diagnosed with multidetector computed tomography (MDCT). MDCT studies for suspected bowel obstruction should focus on four points that need to be mentioned in the report: confirming the obstruction, determining whether there is a single transition point or whether the obstruction is found in a closed loop, establishing the cause of the obstruction, and seeking signs of complications. Identifying signs of ischemia is important in the management of the patient because it enables patients at higher risk of poor outcomes after conservation treatment who could benefit from early surgical intervention to avoid greater morbidity and mortality associated with strangulation and ischemia of the obstructed bowel loop.
Collapse
Affiliation(s)
- J Gómez Corral
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain.
| | - C Niño Rojo
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain
| | - R de la Fuente Olmos
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain
| |
Collapse
|
9
|
Tam AJY, Ahmad SB, Yong C. A timely reminder that prognostication with Gastrograffin is not recommended with closed loop bowel obstruction. ANZ J Surg 2022; 92:3116. [DOI: 10.1111/ans.17958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022]
Affiliation(s)
| | - Saad Bilal Ahmad
- Department of Surgery Maroondah Hospital Melbourne Victoria Australia
| | - Charles Yong
- Department of Surgery Maroondah Hospital Melbourne Victoria Australia
| |
Collapse
|
10
|
Obstrucción intestinal: signos de indicación quirúrgica urgente. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
11
|
Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY) 2022; 47:1660-1683. [PMID: 34191075 DOI: 10.1007/s00261-021-03188-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
Acute bowel ischemia is a condition with high mortality and requires rapid intervention to avoid catastrophic outcomes. Swift and accurate imaging diagnosis is essential because clinical findings are commonly nonspecific. Conventional contrast enhanced CT of the abdomen has been the imaging modality of choice to evaluate suspected acute bowel ischemia. However, subtlety of image findings and lack of non-contrast or arterial phase images can make correct diagnosis challenging. Dual-energy CT provides valuable information toward assessing bowel ischemia. Dual-energy CT exploits the differential X-ray attenuation at two different photon energy levels to characterize the composition of tissues and reveal the presence or absence of faint intravenous iodinated contrast to improve reader confidence in detecting subtle bowel wall enhancement. With the same underlying technique, virtual non-contrast images can help to show non-enhancing hyperdense hemorrhage of the bowel wall in intravenous contrast-enhanced scans without the need to acquire actual non-contrast scans. Dual-energy CT derived low photon energy (keV) virtual monoenergetic images emphasize iodine contrast and provide CT angiography-like images from portal venous phase scans to better evaluate abdominal arterial patency. In Summary, dual-energy CT aids diagnosing acute bowel ischemia in multiple ways, including improving visualization of the bowel wall and mesenteric vasculature, revealing intramural hemorrhage in contrast enhanced scans, or possibly reducing intravenous contrast dose.
Collapse
|
12
|
Demessence R, Lyoubi Y, Feuerstoss F, Hamy A, Aubé C, Paisant A, Venara A. Surgical management of adhesive small bowel obstruction: Is it still mandatory to wait? - An update. J Visc Surg 2022; 159:309-319. [PMID: 35272958 DOI: 10.1016/j.jviscsurg.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Small bowel obstruction syndromes (SBO) represent one of the main causes of emergency admission for surgical abdominal pain. The 2018 Bologna Guidelines (Ten Broek et al. 2018) recommend non-operative management at the outset if there are no signs of severity; surgery is proposed after 72h for the 20-30% of patients who fail medical management. However, these recommendations were based on old studies published at a time when laparoscopic surgery was not commonplace and when diagnostic capabilities (particularly for establishing etiology) were less developed than they are today. Additionally, the advent and development of laparoscopy and enhanced rehabilitation after surgery have led to a decrease in surgical morbidity. These guidelines are therefore now debated and several recent publications have encouraged urgent or semi-urgent surgical management for patients presenting for SBO in order to reduce morbidity, mortality, duration of hospitalization and costs, and to improve the feasibility of therapeutic laparoscopy. Prompt surgical management could also reduce the risk of recurrent small bowel obstructions. This model for early surgical management probably cannot be applied to all patients. It therefore seems important to select those patients at risk for failure of medical treatment and to identify those in whom the probability of successful laparoscopy is high. New radiological tools should allow better selection in the future. At the present time, the indications for early surgery "within 24h" should be emphasized.
Collapse
Affiliation(s)
- R Demessence
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France
| | - Y Lyoubi
- Faculty of Health of Angers, Department of Medicine, Angers, France; Urology Department, CHU d'Angers, 49933 Angers Cedex 9, France
| | - F Feuerstoss
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France
| | - A Hamy
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France
| | - C Aubé
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France
| | - A Paisant
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France
| | - A Venara
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France.
| |
Collapse
|
13
|
Chai Y, Xing J, Lv P, Liang P, Xu H, Yue S, Gao J. Evaluation of ischemia and necrosis in adhesive small bowel obstruction based on CT signs: Subjective visual evaluation and objective measurement. Eur J Radiol 2021; 147:110115. [PMID: 34990890 DOI: 10.1016/j.ejrad.2021.110115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/23/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the diagnostic performance of CT signs for detecting bowel ischemia and necrosis in adhesive small bowel obstruction(SBO) with subjective and objective methods. MATERIALS AND METHODS 113 adhesive SBO patients were enrolled and divided into ischemic group (49 cases in necrotic group and 35 cases in reversible ischemic group) and non-ischemic group (29 cases) according to the operation results. Subjective visual assessment of CT signs associated with ischemia and necrosis was performed by two radiologists independently. Elevated unenhanced attenuation and enhancement value of involved bowel wall were objectively measured and compared by single factor analysis of variance. Cut-off value and diagnostic performance were evaluated by receiver operating characteristic curve (ROC). RESULTS Closed-loop mechanism, reduced bowel wall enhancement, and mesenteric edema were associated with bowel ischemia, with sensitivity of 81.0%, 65.5%, 75.0%, and specificity of 86.2%, 96.6%, 89.7%, respectively. Increased unenhanced bowel wall attenuation was a specific sign for necrosis with 100.0% specificity and 51.0% sensitivity. The sensitivity and specificity for ischemia were 86.0% and 91.9% with cut-off enhancement value lower than 33.5 HU. The sensitivity and specificity for necrosis were 58.2% and 100.0% with cut-off elevated unenhanced attenuation higher than 16.5 HU, 86.7% and 83.3% with cut-off enhancement value lower than 21.5 HU. CONCLUSION Reduced bowel wall enhancement and increased unenhanced bowel wall attenuation were good indicators of bowel ischemia and necrosis. The objective measurement of elevated unenhanced attenuation and enhancement value can predict bowel ischemia and necrosis more accurately.
Collapse
Affiliation(s)
- Yaru Chai
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jingjing Xing
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Peijie Lv
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Huanan Xu
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Songwei Yue
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
| |
Collapse
|
14
|
Correlation of CT findings with intra-operative outcome in closed-loop small bowel obstruction (CL-SBO). Eur J Radiol 2021; 142:109844. [PMID: 34252868 DOI: 10.1016/j.ejrad.2021.109844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
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.
Collapse
|
15
|
Kim J, Lee Y, Yoon JH, Lee HJ, Lim YJ, Yi J, Jung WB. Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment. Eur Radiol 2020; 31:1597-1607. [PMID: 33128599 DOI: 10.1007/s00330-020-07406-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 10/09/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To clarify CT findings that predict outcome of conservative treatment in patients with non-strangulated adhesive small bowel obstruction (SBO). METHODS Unenhanced and contrast-enhanced abdominopelvic CT studies in 189 patients with adhesive SBO who had initial conservative treatment were reviewed. The CT findings included transition zone, beak signs, maximum bowel diameter, bowel diameter ratio, decreased bowel wall enhancement, increased unenhanced bowel wall attenuation, anterior parietal adhesion, bowel wall thickening, closed-loop obstruction, small bowel feces sign, whirl sign, mesenteric haziness, mesenteric, peritoneal fluid, and submucosal edema. These findings were statistically compared according to the success or failure of treatment. RESULTS Conservative treatment succeeded in 144 patients (76.2%) and failed in 45 patients (23.8%). At multivariate analysis, the lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid were independent findings predicting failure of conservative treatment, with odds ratios of 5.23, 5.5, 13.55, and 4.89, respectively. The presence of all significant findings showed a high specificity of 97.2% with positive likelihood ratio of 8.8. If CT scans showed none of the three significant findings, the negative predictive value was 97.6% and negative likelihood ratio was 0.08. CONCLUSIONS The lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid are independent CT findings predicting the failure of conservative treatment in patients with non-strangulated adhesive SBO. The combination of all CT findings suggests the need for surgery; absence of two or all CT findings should suggest an attempt for conservative treatment. KEY POINTS • To minimize delayed operation, it is important to identify non-strangulated adhesive small bowel obstruction patients in whom initial conservative treatment is likely to fail. • The lack of small bowel feces sign, the presence of mesenteric haziness, and a moderate amount of mesenteric fluid are independent factors predicting the failure of conservative treatment in patients with non-strangulated adhesive small bowel obstruction. • The combination of all three CT findings suggests the need for surgery; absence of two or all three CT findings should suggest an attempt for conservative treatment.
Collapse
Affiliation(s)
- Jieun Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yedaun Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea.
| | - Jung-Hee Yoon
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Yun-Jung Lim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Jisook Yi
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Won Beom Jung
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| |
Collapse
|
16
|
Zins M, Millet I, Taourel P. Adhesive Small Bowel Obstruction: Predictive Radiology to Improve Patient Management. Radiology 2020; 296:480-492. [PMID: 32692296 DOI: 10.1148/radiol.2020192234] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adhesive small bowel obstruction (SBO) remains one of the leading causes of emergency room visits and is still associated with high morbidity and mortality rates. Because the management of adhesive SBO has shifted from immediate surgery to nonoperative treatment in the absence of ischemia, it is crucial to rapidly detect or predict strangulation, which requires emergent surgery. CT is now established as the best imaging technique for the initial assessment of patients suspected of having adhesive SBO. CT helps confirm the diagnosis of mechanical SBO, locate the site of obstruction, establish the cause, and detect complications. This article is a review of the role of imaging in answering specific questions to help predict the management needs of each individual patient. It includes (a) an update on the best CT signs for predicting ischemia and a need for bowel resection; (b) a discussion of the CT features that help differentiate open-loop from closed-loop obstruction and a single adhesive band from matted adhesions and how these differences can influence the management; and (c) a review of the main CT predictors of the success or failure of nonoperative management in adhesive SBO.
Collapse
Affiliation(s)
- Marc Zins
- From the Department of Medical Imaging, Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France (M.Z.); Department of Medical Imaging, Lapeyronie Hospital, Montpellier, France (I.M., P.T.); and Department of Medical Imaging, University of Montpellier, Montpellier, France (I.M., P.T.)
| | - Ingrid Millet
- From the Department of Medical Imaging, Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France (M.Z.); Department of Medical Imaging, Lapeyronie Hospital, Montpellier, France (I.M., P.T.); and Department of Medical Imaging, University of Montpellier, Montpellier, France (I.M., P.T.)
| | - Patrice Taourel
- From the Department of Medical Imaging, Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France (M.Z.); Department of Medical Imaging, Lapeyronie Hospital, Montpellier, France (I.M., P.T.); and Department of Medical Imaging, University of Montpellier, Montpellier, France (I.M., P.T.)
| |
Collapse
|