Value of MSCT for diagnosis, localization and management of obstructive small bowel obstruction

Introduction: To retrospectively evaluate accuracy of MSCT for localization of adhesions in patients with small bowel obstruction in reference to surgical findings. Furthermore to evaluate different contrast applications to localize the adhesion. Methods: Between 2006 and 2008, 89 consecutive patients with surgically confirmed adhesive small bowel obstruction under-went abdominal CT and subsequent surgery. Three gastrointestinal radiologists performed blinded, independent and retrospec-tive review of the CT scans. Initial evaluation was performed on axial scans and after 4 weeks delay on axial scans with coronal reformations. To specify the location of an adhesion the abdomen was divided in 6 quadrants. Reference standard for the locali-zation was the surgical finding during operation. Results: Intraoperative results showed adhesions in 52.8% in the pelvis. Second most common in the upper middle part (19.1%). Accuracy of localization in the axial images by three radiologists was 73% and 81.3% when combined axial images with coronal reformations. No significant difference was seen for different contrast media applied. Conclusions: Patients presenting with clear clinical signs of ileus should be treated conservatively whenever possible due to a high in-house mortality when undergoing surgery. In case of surgery, small bowel obstruction is mainly due to adhesions or peri-toneal carcinomatosis and mostly located in the pelvis. Radiological imaging before operation is not always necessary. The be-nefit of MSCT is to exclude other differential diagnosis or complications. If a CT scan is performed, combined axial images with coronal reformations should be preferred and contrast media should be applied orally and intravenously.