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Emerg Med J. 2007 November; 24(11): 790–791.
PMCID: PMC2658332

Computed tomography for small bowel obstruction

Computed tomography for small bowel obstruction

Report by Usman Jaffer

Checked by Amin Alyas

Abstract

A short cut review was carried out to establish whether computed tomography (CT) is useful in the management of patients with suspected acute small bowel obstruction (SBO). A total of 348 papers were found using the reported search and manually cross referencing papers, of which 16 represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are presented in table 33.. The clinical bottom line is that CT is a useful investigation in patients presenting with suspected SBO.

Table thumbnail
Table 3

Three part question

In an [adult patient presenting with suspected SBO] is [CT] useful in [the diagnosis of obstruction and strangulation].

Clinical scenario

A 65‐year‐old woman presents to the emergency department with signs and symptoms of SBO. She had previously had an abdominal hysterectomy. Plain abdominal radiograph (AXR) is non‐specific. You wonder whether abdominal CT would be useful in the management of a patient with presumptive SBO.

Search strategy

Medline 1950 to March 2006 using the OVID interface, combined with manual cross‐referencing (exp Intestinal obstruction/AND exp Intestine, Small/AND exp Tomography, X‐Ray Computed/) AND ((intestinal adj obstruction) AND CT).mp. limit to (humans and English language).

Search outcome

A total of 491 papers were found of which 16 were relevant to the topic and one systematic review incorporating 11 of these papers (table 33).

Comments

Published literature supports the use of CT as a sensitive and specific test for small bowel obstruction. The evidence supports the proposal that CT provides reliable information regarding cause of the obstruction and presence of bowel strangulation.

Clinical bottom line

CT is a useful investigation in patients presenting with suspected SBO.

References

  • Beall D P, Fortman B J, Lawler B C. et al. Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography. Clin Radiol 2002;57:719-24. [PubMed]
  • Ha H K, Kim J S, Lee M S. et al. Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria. Radiology 1997;204:507-12. [PubMed]
  • Lazarus D E, Slywotsky C, Bennett G L. et al. Frequency and relevance of the “small-bowel feces” sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol 2004;183:1361-6. [PubMed]
  • Scaglione M, Grassi R, Pinto A. et al. [Positive predictive value and negative predictive value of spiral CT in the diagnosis of closed loop obstruction complicated by intestinal ischemia]. Radiol Med (Torino) 2004;107:69-77. [PubMed]
  • Suri S, Gupta S, Sudhakar P J. et al. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol 1999;40:422-8. [PubMed]
  • Mallo R D, Salem L, Lalani T. et al. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg 2005;9:690-4. [PubMed]

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