| 1. Nicolaou S, Kai B, Ho S, Su J, Ahamed K. Imaging of acute small-bowel obstruction. [Review] [8 refs]. AJR Am J Roentgenol. 185(4):1036-44, 2005 Oct. |
Review/Other-Dx |
N/A |
To review the different imaging techniques used for diagnosing small-bowel obstruction |
Results not stated in abstract. |
4 |
| 2. Frager D, Baer JW, Medwid SW, Rothpearl A, Bossart P. Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT. AJR. 1996; 166(1):67-71. |
Observational-Dx |
60 patients |
To determine whether CT can be used to diagnose ischemia of the small intestine in patients with SBO due to adhesions or hernia. Prospective determination was made based on the CT as to whether there was any associated intestinal ischemia. |
Ischemia was prospectively diagnosed on the basis of CT findings in 68% of the patients. Sensitivity 100%, specificity 61%. The multivariate analysis corroborated the prospective results by showing high sensitivity (90%) and diminished specificity (50%-64%). Bowel-wall thickening and high attenuation of the bowel wall were the most important signs of ischemia on unenhanced CT scans, whereas abnormal bowel-wall enhancement and mesenteric fluid correlated best on enhanced CT examinations. |
3 |
| 3. Balthazar EJ, Liebeskind ME, Macari M. Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology. 1997; 205(2):519-522. |
Observational-Dx |
100 patients |
To determine the accuracy of CT in the diagnosis of intestinal ischemia in patients with possible SBO. |
CT had sensitivity 83%, specificity 93%, accuracy 91%, PPV 79%, NPV 95%. CT helps in the accurate detection of bowel ischemia, especially when SBO is present. |
3 |
| 4. Frager D, Medwid SW, Baer JW, Mollinelli B, Friedman M. CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause. AJR. 1994; 162(1):37-41. |
Observational-Dx |
85 patients |
To determine whether CT is superior to clinical-radiographic evaluation in diagnosing and assessing the cause of SBO. Gold standard for diagnosis was surgical findings in 61 cases and clinical course in 29 cases. |
For combined clinical-radiographic findings, diagnosis was complete obstruction in 21/46 cases (sensitivity 46%). For CT, diagnosis was established in all 46 cases (sensitivity 100%). For combined clinical-radiographic findings, partial obstruction of the small bowel was diagnosed in 6/20 cases (sensitivity 30%), whereas all cases were detected with CT. CT is sensitive for diagnosing complete obstruction of the small bowel and for determining the location and cause of obstruction while the traditional clinical and plain film evaluation is relatively insensitive. |
3 |
| 5. Fukuya T, Hawes DR, Lu CC, Chang PJ, Barloon TJ. CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR. 1992; 158(4):765-769; discussion 771-762. |
Observational-Dx |
60 patients |
To retrospectively compare the CT findings in patients with and without surgically proved SBO to evaluate the role of CT in diagnosing the presence and cause of obstruction. In patients with obstruction, CT findings were compared with findings on plain abdominal radiographs and contrast studies of the small intestine. |
CT correctly detected SBO in 90%. Radiographs showed SBO in 80%. CT provided more info than contrast studies regarding cause of obstruction. CT scanning accurately shows the presence of HGSBO and may be the technique of choice when extraluminal abnormalities are suspected or when prompt, efficient, and comprehensive evaluation is required. |
3 |
| 6. Gazelle GS, Goldberg MA, Wittenberg J, Halpern EF, Pinkney L, Mueller PR. Efficacy of CT in distinguishing small-bowel obstruction from other causes of small-bowel dilatation. AJR. 1994; 162(1):43-47. |
Observational-Dx |
75 patients (27 obstruction 16 other surgical diagnosis, and 32 no surgery) |
To evaluate efficacy of CT in distinguishing SBO from other causes of small-bowel dilatation. |
Observer A: correct in 89%, 88%, and 72% of cases in the obstruction, other surgical diagnosis, and no surgery groups, respectively. Observer B: correct in 78%, 81%, and 69% of cases in the obstruction, other surgical diagnosis, and no surgery groups, respectively. CT can be useful for evaluating small-bowel dilatation and can aid both the diagnosis of SBO and its differentiation from other conditions resulting in small-bowel dilatation. |
3 |
| 7. Maglinte DD, Reyes BL, Harmon BH, et al. Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR. 1996; 167(6):1451-1455. |
Observational-Dx |
78 patients |
To compare the reliability and define the role of radiography and CT in the assessment of SBO. |
Radiography: sensitivity 69%, specificity 57%, accuracy 67%. CT: sensitivity 64%, and specificity 79%, accuracy 67%. High-grade partial obstruction, radiography and CT: sensitivity 86%, specificity 82%. Low grade partial obstruction: radiography and CT: sensitivity 56%, specificity 50%. CT revealed the cause of the SBO in 95% of those patients who CT correctly showed the obstruction. |
2 |
| 8. Ha HK, Kim JS, Lee MS, et al. Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria. Radiology. 1997; 204(2):507-512. |
Observational-Dx |
84 patients |
Retrospective review to evaluate the usefulness of known CT criteria for the differentiation of simple and strangulated SBO. |
CT findings that enabled the detection of strangulated obstructions were poor or no enhancement of bowel wall (sensitivity 34%, specificity 100%) and a serrated beak (sensitivity 32%, specificity 100%). |
2 |
| 9. Loftus T, Moore F, VanZant E, et al. A protocol for the management of adhesive small bowel obstruction. J Trauma Acute Care Surg. 78(1):13-9; discussion 19-21, 2015 Jan. |
Observational-Tx |
91 Patients |
To implement a standardized protocol for the management of adhesive small bowel obstruction (aSBO) in order to identify complete obstruction early, resolve partial obstruction, operate within 3 days of admission when necessary, and decrease hospital length of stay (HLOS). |
Over 1 year, 91 patients were admitted with aSBO. Sixty-three patients received Gastroview (GV), of whom 51% underwent surgery. Twenty-four patients went directly to the operating room because of clinical or imaging findings suggesting bowel ischemia. Average time to surgery was within 1 day for the no-GV group and 2 days for the GV group. Patients passing GV to the colon within 5 hours of administration had a 90% rate of resolution of obstruction. There was a direct relationship between the duration of time before passing GV to the colon and hospital length of stay (HLOS) (r 2 = 0.459). Patients who received GV and did not require surgery had lower HLOS (3 days vs. 11 days, p < 0.0001). |
2 |
| 10. Walters CL, Sutton AL, Huddleston-Colburn MK, Whitworth JM, Schneider KE, Straughn JM Jr. Outcomes of gynecologic oncology patients undergoing gastrografin small bowel follow-through studies. J Reprod Med. 59(9-10):476-80, 2014 Sep-Oct. |
Observational-Dx |
70 Patients |
To characterize the outcomes of gynecologic oncology patients undergoing small bowel follow-throughs (SBFTs) with Gastrografin at our institution. |
Seventy patients underwent 79 SBFT examinations with Gastrografin to evaluate their bowel dysfunction. The overall rate of operative intervention was 23%. A total of 69% of patients with a complete obstruction underwent surgery as compared to 21% of patients with a partial obstruction (p = 0.002). Return of bowel function was significantly longer in patients with complete obstructions as compared to patients with partial obstructions (48 vs. 8 hours, p = 0.006). Length of stay was longest in patients with complete obstructions. |
4 |
| 11. Bueno-Lledo J, Barber S, Vaque J, Frasson M, Garcia-Granero E, Juan-Burgueno M. Adhesive Small Bowel Obstruction: Predictive Factors of Lack of Response in Conservative Management with Gastrografin. Dig Surg. 33(1):26-32, 2016. |
Observational-Tx |
223 Patients |
To identify variables with negative influence in nonoperative management with gastrografin. |
One hundred and ninety eight episodes responded to nonoperative treatment (84.2% of success) and 33 patients (15.8%) required surgical intervention. Only 3 patients of the gastrografin cohort with contrast in colon, required surgery. Predictive factors of failure of nonoperative management with gastrografin were patients aged above 65 (p = 0.01; OR 1.791, 95% CI 1.41-2.19), with a history of 2 or more previous laparotomies (p = 0.03; OR 2.91, 95% CI 2.19-3.71), and who had undergone previous abdominal surgery due to ASBO (p = 0.002; OR 1.381, 95% CI 1.10-1.79). |
2 |
| 12. Goussous N, Eiken PW, Bannon MP, Zielinski MD. Enhancement of a small bowel obstruction model using the gastrografin challenge test. J Gastrointest Surg. 17(1):110-6; discussion p.116-7, 2013 Jan. |
Observational-Tx |
125 Patients |
To determine if the Gastrografin (GG) challenge test, when used in combination with our prior model, will decrease the rate of explorations in patients not meeting the criteria for immediate small bowel obstruction (SBO) operation. |
One hundred and twenty-five patients with a diagnosis of small bowel obstruction were identified wherein 47 % were males. Fifty-three received a GG challenge (study), and 72 did not have a GG challenge (historic). There was no difference in age (70 vs 65 years), history of prior SBO (51 vs 49 %), history of diabetes mellitus (21 vs 18 %), history of malignancy (32 vs 39 %), or cardiac disease (30 vs 39 %). Both groups had similar number of previous abdominal operations (two vs two). The presence of mesenteric edema (68 vs 75 %), the lack of small bowel fecalization (47 vs 46 %), and a history of obstipation (25 vs 24 %) were similar in both groups. Patients in the study group had a lesser rate of abdominal exploration (25 vs 42 %, p?=?0.05) and fewer complications (13 vs 31 %, p?=?0.02) compared to the historic control group. There was equivalent incidence of ischemic bowel (4 vs 7 %), duration of hospital stay (4 vs 7 days), duration from admission to operation (2 vs 3 days), and mortality (8 vs 6 %); 44 patients had a successful GG challenge with nine failures. There was a greater rate of exploration in patients with a failed challenge compared to those with a successful challenge (89 vs 11 %, p?<?0.01). |
2 |
| 13. Khasawneh MA, Ugarte ML, Srvantstian B, Dozois EJ, Bannon MP, Zielinski MD. Role of gastrografin challenge in early postoperative small bowel obstruction. J Gastrointest Surg. 18(2):363-8, 2014 Feb. |
Observational-Tx |
116 Patients |
To determine if a Gastrografin (GG) challenge test will reduce need for re-exploration in patients with early small bowel obstruction (SBO). |
One hundred sixteen patients received a Gastrografin challenge. There were 87 males in each group with an average age of 62 years. A laparoscopic approach in the index operation was done equally between groups (18 vs. 18 %). There was no difference between groups in operative re-exploration rates (14 vs. 10 %); however, hospital duration of stay was greater in patients who received Gastrografin challenge (17 vs. 13 days). Two in hospital deaths occurred, one in each group, both of infectious complications. |
4 |
| 14. Abbas SM, Bissett IP, Parry BR. Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. [Review] [25 refs]. Br J Surg. 94(4):404-11, 2007 Apr. |
Meta-analysis |
6 Studies |
To analyze the role of Gastrografin as a diagnostic and therapeutic agent in the management of adhesive small bowel obstruction. |
The appearance of water-soluble contrast agent in the colon on an abdominal radiograph within 24 h of its administration predicted resolution of obstruction with a pooled sensitivity of 97 per cent and specificity of 96 per cent. The area under the summary ROC curve was 0.98. Water-soluble contrast agent did not reduce the need for surgical intervention (odds ratio 0.81, P = 0.300), but it did reduce the length of hospital stay for patients who did not require surgery compared with placebo (weighted mean difference--1.84 days; P < 0.001). |
Inadequate |
| 15. Feigin E, Seror D, Szold A, et al. Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trial. Am J Surg. 171(2):227-9, 1996 Feb. |
Observational-Tx |
50 Patients |
To examine the use of meglumine ioxitalamate as a supplement to the standard conservative treatment of postoperative small-bowel obstruction (POSBO). |
Seven (14%) patients required surgery: 3 in the contrast material group and 4 in the control group (P = not significant [NA]. Resolution of symptoms was achieved in nonsurgical patients within an average of 25.7 hours in the contrast material group and 28.7 hours in the control group (P = NS). There was no mortality in this study. In 2 (4%) patients (1 in each group), strangulated bowel was found during surgery, but only the 1 (2%) patient in the contrast material group required bowel resection. No difference was found in the length of hospital stay or rate of complications. There were no complications that could be attributed to the use of the contrast material itself. |
2 |
| 16. Biondo S, Miquel J, Espin-Basany E, et al. A Double-Blinded Randomized Clinical Study on the Therapeutic Effect of Gastrografin in Prolonged Postoperative Ileus After Elective Colorectal Surgery. World J Surg. 40(1):206-14, 2016 Jan. |
Experimental-Tx |
58 Patients |
To study the impact of oral Gastrografin® administration on postoperative prolonged ileus (PPI) after elective colorectal surgery. |
Twenty-nine patients per group were randomized. Groups were comparable for age, gender, ASA Physical Status Classification System, stoma construction, and surgical technique. No statistical differences were observed in mean time to resolution between the two groups, 9.1 days (CI 95 %, 6.51–11.68) in Gastrografin® group versus 10.3 days (CI 6.96–10.29) in Placebo group (P = 0.878). Even if not statistically significant, time of resolution of PPI, overall length of stay, time of need of nasogastric tube, and time to tolerance of oral intake were shorter in the G group. |
1 |
| 17. Megibow AJ, Balthazar EJ, Cho KC, Medwid SW, Birnbaum BA, Noz ME. Bowel obstruction: evaluation with CT. Radiology. 1991; 180(2):313-318. |
Observational-Dx |
84 patients (64 with intestinal obstruction) |
Retrospective study to assess CT in diagnosing and characterizing bowel obstruction. |
CT had sensitivity of 94%, specificity 96%, and accuracy 95%. Cause of obstruction was correctly predicted in 47 64 cases (73%). CT useful in patients with a history of abdominal malignancy and patients who have not been operated on and who have signs of infection, bowel infarction, or a palpable abdominal mass. |
3 |
| 18. Shrake PD, Rex DK, Lappas JC, Maglinte DD. Radiographic evaluation of suspected small bowel obstruction. Am J Gastroenterol. 1991; 86(2):175-178. |
Review/Other-Dx |
117 consecutive patients |
Abdominal radiographs and enteroclysis studies were reviewed blindly in patients undergoing enteroclysis for suspected SBO. |
For patients with normal or abnormal nonspecific radiographs, SBO was shown by enteroclysis in 22%. For patients with obstruction on radiographs, 42% had either normal enteroclysis studies or only minor adhesions. Enteroclysis correctly predicted the presence of obstruction in 100%, the absence of obstruction in 88%, the level (proximal vs distal) of obstruction in 89%, and the etiology of obstruction in 86% of operated patients. Enteroclysis is recommended in patients with clinical uncertainty about the diagnosis of SBO. |
4 |
| 19. Delabrousse E, Lubrano J, Jehl J, et al. Small-bowel obstruction from adhesive bands and matted adhesions: CT differentiation. AJR. 2009; 192(3):693-697. |
Observational-Dx |
67 consecutive patients |
Retrospective study to evaluate CT findings that can help to differentiate SBO due to adhesive bands from SBO caused by matted adhesions. |
Compared with SBO cases from matted adhesions, significantly more SBO cases that were due to adhesive bands showed a beak sign (P=0.0001) and fat notch sign (P=0.0001). The small-bowel feces sign was more frequently seen in cases of SBO from matted adhesions (P=0.014). Bowel ischemia and bowel necrosis were more frequent findings with adhesive bands than with matted adhesions (P=0.011 and P=0.049, respectively). The location in the pelvis of the adhesive structure (P=0.039) and a higher rate of accidental bowel perforation (P=0.031) were associated with matted adhesions. CT is useful for differentiating SBO caused by adhesive bands from SBO due to matted adhesions. |
3 |
| 20. Delabrousse E, Lubrano J, Sailley N, Aubry S, Mantion GA, Kastler BA. Small-bowel bezoar versus small-bowel feces: CT evaluation. AJR. 2008; 191(5):1465-1468. |
Observational-Dx |
46 consecutive patients: 27 CT exams. 2 reviewers |
Retrospective study to evaluate the accuracy of CT for differentiating small-bowel bezoar from small-bowel feces in cases of SBO. |
In cases of SBO, although some CT features of bezoars and small-bowel feces overlap, a well-defined mass mottled with gas bubbles associated with an encapsulating wall, the newly described “floating fat-density debris” sign, and a lesion in the stomach that appears similar to the obstructing mass is typical of a small-bowel bezoar; an isolated amorphous mass mottled with gas bubbles is typical of small-bowel feces. |
4 |
| 21. Jaffe TA, Martin LC, Thomas J, Adamson AR, DeLong DM, Paulson EK. Small-bowel obstruction: coronal reformations from isotropic voxels at 16-section multi-detector row CT. Radiology. 2006; 238(1):135-142. |
Observational-Dx |
100 consecutive patients: 3 blinded reviewers |
To retrospectively assess the added value of coronal reformations using 16-section MDCT for the diagnosis of SBO. |
Mean sensitivity and specificity of CT scout alone, transverse CT alone, and transverse plus coronal CT for the diagnosis of SBO were 88% and 86%, 87% and 87%, and 87% and 90%, respectively. Coronal reformations add confidence to the diagnosis and exclusion of SBO. |
2 |
| 22. Desser TS, Gross M. Multidetector row computed tomography of small bowel obstruction. Semin Ultrasound CT MR. 2008; 29(5):308-321. |
Review/Other-Dx |
N/A |
Review role of MDCT in the evaluation of patients with uncomplicated and complicated SBO. |
CT has become a mainstay in the evaluation of patients with known or suspected SBO during the past two decades. Current generation MDCT scanners, with their isotropic resolution, now permit high-quality reformatted images to be obtained in multiple planes and facilitate identification of the transition point and other findings in SBO. |
4 |
| 23. Gollub MJ. Multidetector computed tomography enteroclysis of patients with small bowel obstruction: a volume-rendered "surgical perspective". J Comput Assist Tomogr. 2005; 29(3):401-407. |
Review/Other-Dx |
N/A |
To examine use of MDCT enteroclysis in patients with SBO. |
MDCT enteroclysis with the use of positive oral contrast allows volume-rendered type images of the intestines to provide a unique perspective on the location and relations of the various causes of SBO not previously available. |
4 |
| 24. Hodel J, Zins M, Desmottes L, et al. Location of the transition zone in CT of small-bowel obstruction: added value of multiplanar reformations. Abdom Imaging. 2009; 34(1):35-41. |
Observational-Dx |
69 consecutive patients |
To assess the additional value of MPR in comparison with axial images alone for location of the transition zone in CT of mechanical SBO. |
Accuracy of transition zone location for reader 1 and reader 2 was 86% and 84% with axial slices alone, and by using MPR 93% (significant: P=0.03) and 90% (not significant: P=0.08), respectively. Mean confidence score was significantly increased for both readers using MPR: 0.3 higher (P=0.0001) and 0.37 higher (P=0.0001) respectively. MPR can increase both accuracy and confidence in the location of the transition zone in CT of SBO. |
2 |
| 25. Hong SS, Kim AY, Byun JH, et al. MDCT of small-bowel disease: value of 3D imaging. AJR. 2006; 187(5):1212-1221. |
Review/Other-Dx |
N/A |
To show the various clinical applications of MDCT enterography for evaluating small-bowel disease, with a focus on the added value of 3D imaging. |
MDCT and refined 3D imaging processes can offer a full examination of the small bowel as well as powerful information about the bowel and its surrounding structures. |
4 |
| 26. Shah ZK, Uppot RN, Wargo JA, Hahn PF, Sahani DV. Small bowel obstruction: the value of coronal reformatted images from 16-multidetector computed tomography--a clinicoradiological perspective. J Comput Assist Tomogr. 2008; 32(1):23-31. |
Observational-Dx |
30 patients |
Retrospective study to assess performance of 16-MDCT for SBO with surgery as standard of reference. To assess the impact of coronal reformats on reader confidence, and to address management perspective and surgeon's assessment of coronal images. |
Results showed that the recorded accuracies were slightly higher for etiology, transition site, and complications using the combination data set; this reached statistical significance for etiology only (P=0.08). There was no significant increase in scan evaluation time with addition of coronal images. Surgeon considered the coronal images more informative as compared with the axial images in 76.6% of cases. Coronal images generated at the scanner console are complementary to axials and improve reader confidence. Surgeons find coronal images more helpful than axial images for management. |
3 |
| 27. Colon MJ, Telem DA, Wong D, Divino CM. The relevance of transition zones on computed tomography in the management of small bowel obstruction. Surgery. 2010; 147(3):373-377. |
Observational-Dx |
200 patients; 150 had RTZ (75 required operative intervention; 58 had RTZ and 17 did not have RTZ) |
To determine the surgical predictive value and intraoperative accuracy of RTZ. A retrospective review of patients with SBO who underwent abdominal CT at a single institution. |
The presence of RTZ was not associated with increased probability of operative vs nonoperative management (OR=1.19; 95% CI [0.61-2.32]). The mean time to operative intervention was 3.6 days. Immediate operative intervention (<24 hours) was equivalent in patients with vs without RTZ (57% vs 53%; P=N/S) as was intervention for failed nonoperative management (43% vs 47%; P=N/S). For patients who required operative intervention, RTZ correlated with intraoperative site of obstruction in only 31 (63%) patients. |
4 |
| 28. Idris M, Kashif N, Idris S, Memon WA, Tanveer UH, Haider Z. Accuracy of 64-slice multidetector computed tomography scan in detection of the point of transition of small bowel obstruction. Jpn J Radiol. 30(3):235-41, 2012 Apr. |
Observational-Dx |
59 Patients |
To determine the accuracy of 64-slice multidetector computed tomography scans in detecting the point of transition of small bowel obstruction by using surgical findings as the gold standard. |
Out of 59 patients, 64-slice MDCT was able to detect the point of transition of SBO in 90% (53/59) of patients, while in 10% (6/59) of these patients the point of transition was not found on MDCT. Overall for detection of the point of transition of small bowel obstruction 64-slice MDCT has 93% sensitivity, 67% specificity, 98% positive predictive value, 33% negative predictive value and 92% accuracy, respectively. |
3 |
| 29. Atri M, McGregor C, McInnes M, et al. Multidetector helical CT in the evaluation of acute small bowel obstruction: comparison of non-enhanced (no oral, rectal or IV contrast) and IV enhanced CT. Eur J Radiol. 2009; 71(1):135-140. |
Observational-Dx |
99 patients |
To compare accuracy of nonenhanced CT (no oral or IV contrast) and enhanced CT (IV enhanced only) to diagnose SBO and evaluate reviewer's experience impact. |
Mechanical obstruction was present in 56% (59/105). The average sensitivity, specificity, NPV and PPV and accuracy values for nonenhanced CT were 88.1% (CI: 80%-96%), 77% (CI: 65%-89%), 83.0% (CI: 72%-95%), 83% (CI: 74%-92%), and 83% (CI: 76%-90%) with no significant difference between three reviewers. The corresponding numbers for enhanced CT were 87.6% (CI: 79%-96%), 75% (CI: 63%-88%), 82.6.0% (CI: 71%-94%), 82.1% (CI: 73%-92%), and 82% (CI: 75%-90%) (P>0.5). Area under curve of ROC curves of three reviewers did not show significant statistical difference (P>0.5). |
2 |
| 30. Donckier V, Closset J, Van Gansbeke D, et al. Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction. Br J Surg. 1998; 85(8):1071-1074. |
Observational-Dx |
54 patients |
Prospective study to evaluate the contribution of CT to decision making in the management of adhesive SBO. |
CT demonstrated signs of strangulation or volvulus in 19 patients, including 3 with signs of peritoneal irritation. Within this group, urgent laparotomy was performed in 17 patients and confirmed the CT diagnosis in 16. 37 patients without clinical or CT signs of complications had initial conservative treatment; among them, 7/12 with a distal obstruction determined by CT required a delayed operation for persisting obstruction, compared with 2/25 patients with a proximal obstruction (P<0.01). |
4 |
| 31. Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV. Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR. 2000; 175(6):1601-1607. |
Observational-Dx |
144 exams in 142 patients |
To prospectively determine the value of helical CT in detecting signs of ischemia complicating SBO. |
CT had sensitivity of 96%, specificity 93%, NPV 99%. Reduced enhancement of the bowel wall had a sensitivity of 48% and specificity of 100%, mural thickening had a sensitivity of 38% and specificity of 78%, mesenteric fluid had a sensitivity of 88% and specificity of 90%, congestion of mesenteric veins had a sensitivity of 58% and specificity of 79%, and ascites had a sensitivity of 75% and specificity of 76%. |
3 |
| 32. Millet I, Taourel P, Ruyer A, Molinari N. Value of CT findings to predict surgical ischemia in small bowel obstruction: A systematic review and meta-analysis. [Review]. European Radiology. 25(6):1823-35, 2015 Jun. |
Meta-analysis |
9 studies |
To assess the diagnostic performance in determining strangulation in small bowel obstruction (SBO) for five CT findings commonly considered in published small bowel obstruction (SBO) management guidelines. |
A total of 768 patients, including 205 with strangulation from nine studies, were evaluated. The reduced bowel wall enhancement CT sign had the highest specificity (95 %, CI 75–99), with a positive LR of 11.07 (2.27–53.88) and DOR of 22.86 (4.99–104.61). The mesenteric fluid sign had the highest sensitivity (89 %, CI 75–96) with a negative LR of 0.16 (0.07–0.39) and a DOR of 13.9 (5.73–33.75). The bowel wall thickness had a sensitivity of 48 % (CI 41–54), a specificity of 83 % (CI 74–89), a positive LR of 2.84 (1.83–4.41) and a negative LR of 0.62 (0.53–0.72). The other CT findings had lower diagnostic performance. |
Inadequate |
| 33. Elsayes KM, Menias CO, Smullen TL, Platt JF. Closed-loop small-bowel obstruction: diagnostic patterns by multidetector computed tomography. J Comput Assist Tomogr. 2007; 31(5):697-701. |
Review/Other-Dx |
N/A |
To review the imaging features of closed-loop bowel obstruction and various underlying conditions. Special emphasis is placed on the technique of MDCT and its role in diagnosing this entity. |
MDCT is a highly accurate method in evaluating high-grade intestinal obstruction. |
4 |
| 34. Nakashima K, Ishimaru H, Fujimoto T, et al. Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction. Abdom Imaging. 40(5):1097-103, 2015 Jun. |
Observational-Dx |
35 Patients |
To investigate the diagnostic performance of contrast-enhanced CT (CECT) findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction (CL-SBO). |
High attenuation of the bowel wall, intraperitoneal air, reduced enhancement of the mesenteric arteries, and small-bowel feces signs showed high specificities of 100%, 100%, 89%, and 89% but low sensitivities of 31%, 25%, 44%, and 31%, respectively, for the prediction of bowel necrosis in CL-SBO. According to multivariate logistic regression analysis, reduced bowel-wall enhancement, reduced enhancement of the mesenteric veins, and a lack of engorgement of the mesenteric veins were significant for predicting bowel ischemia or necrosis (P < 0.05). |
3 |
| 35. Sheedy SP, Earnest F 4th, Fletcher JG, Fidler JL, Hoskin TL. CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology. 241(3):729-36, 2006 Dec. |
Observational-Dx |
60 patients; 2 reviewers |
Retrospective study to evaluate the diagnostic performance of CT for detection of ischemic complications of SBO in emergency department patients and compare prospective interpretation with retrospective interpretation using surgical or pathologic findings as the reference standard. |
Sensitivity and specificity for the diagnosis of ischemia were, respectively, 14.8% and 94.1% for prospective interpretations, 29.6% and 91.2% for reader 1, 40.7% and 85.3% for reader 2, and 51.9% and 88.2% for the consensus review. Decreased segmental enhancement was the most specific sign for small-bowel ischemia. Diagnostic performance assessment of CT for diagnosis of ischemic complication of SBO revealed poor prospective interpretation sensitivity. |
3 |
| 36. Wiesner W, Mortele K. Small bowel ischemia caused by strangulation in complicated small bowel obstruction. CT findings in 20 cases with histopathological correlation. JBR-BTR. 2011; 94(6):309-314. |
Review/Other-Dx |
20 patients |
To analyze the CT findings in cases of complicated SBO with surgically and histopathologically proven small bowel ischemia, caused by extrinsic venous outflow obstruction of the affected bowel loops and to discuss the question, if bowel wall thickening, abnormal bowel wall enhancement, ascites and mesenteric stranding correlate with the severity of bowel wall damage. |
Small bowel wall thickening, local mesenteric stranding and ascites were equally common in both groups of patients, regardless of whether obstruction and strangulation related small bowel ischemia was transmural or only partial mural. Out of those patients who were examined by contrast enhanced studies no patient showed lack of enhancement along the ischemic bowel loops. |
4 |
| 37. Geffroy Y, Boulay-Coletta I, Julles MC, Nakache S, Taourel P, Zins M. Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction. Radiology. 270(1):159-67, 2014 Jan. |
Observational-Dx |
44 Patients |
To evaluate performance of increased bowel-wall attenuation on unenhanced 64-section multidetector computed tomographic (CT) images for diagnosing bowel-wall ischemia in patients with mechanical small-bowel obstruction (SBO) and to evaluate the diagnostic accuracy of multidetector CT in detecting small-bowel ischemia complicating SBO, with surgical and histopathologic findings as reference standard. |
In 19 of 45 (42%) multidetector CT scans, ischemia was confirmed at surgery and/or histopathologic examination. Increased bowel-wall attenuation on unenhanced images was significantly associated with ischemia (P < .0001); in this highly selected population, this sign had a 100% (24 of 24) specificity and a 56% (10 of 18) sensitivity. Sensitivity and specificity of multidetector CT for ischemia were 63% (12 of 19) and 92% (24 of 26), respectively, for the prospective reports and 84% (16 of 19) and 96% (25 of 26), respectively, for the consensus review. Decreased segmental bowel-wall enhancement was the most accurate 64-section multidetector CT sign for diagnosing ischemia (sensitivity, 78% [14 of 18]; specificity, 96% [24 of 25]; P < .0001). The small-bowel feces sign was significantly associated with ischemia (P = .0308). |
3 |
| 38. O'Leary MP, Neville AL, Keeley JA, Kim DY, de Virgilio C, Plurad DS. Predictors of Ischemic Bowel in Patients with Small Bowel Obstruction. Am Surg. 82(10):992-994, 2016 Oct. |
Observational-Dx |
116 Patients |
To identify preoperative variables associated with ischemic bowel found at operative exploration. |
One hundred and sixteen patients underwent exploratory surgery for SBO. Mean age was 52 ± 14 years and most were male [64 (55.2%)]. Adhesions [92 (79.3%)] were the most common etiology of obstruction. Leukocytosis (P = 0.304) and acidosis (P = 0.151) were not significantly associated with ischemia or ischemic perforation. In addition, history of prior SBO (P = 0.618), tachycardia (P = 0.111), fever (P = 0.859), and time from admission to operation (P = 0.383) were not predictive of ischemic bowel. However, hyponatremia (=134 mmol/L) and CT scan findings of wall thickening or a suspected closed loop were independently associated with bowel ischemia. |
4 |
| 39. Darras KE, McLaughlin PD, Kang H, et al. Virtual monoenergetic reconstruction of contrast-enhanced dual energy CT at 70keV maximizes mural enhancement in acute small bowel obstruction. European Journal of Radiology. 85(5):950-6, 2016 May. |
Observational-Dx |
72 Patients |
To evaluate the quantitative and qualitative benefits of virtual monoenergetic image (VMI) reconstruction in the assessment of small bowel mural enhancement on dual source dual energy computed tomography (CT) scans of the abdomen. |
Optimal contrast to noise ratio (CNR) values for small intestinal mural enhancement were observed at 70keV. Qualitative assessment revealed that there was no statistical difference in diagnostic accuracy between VMI and PCI. All readers reported improved confidence when assessing the contrast enhancement on the 70keV VMI dataset and in our series, 2 additional cases of ischemia were identified on this reconstruction. |
4 |
| 40. Potretzke TA, Brace CL, Lubner MG, Sampson LA, Willey BJ, Lee FT Jr. Early small-bowel ischemia: dual-energy CT improves conspicuity compared with conventional CT in a swine model. Radiology. 275(1):119-26, 2015 Apr. |
Observational-Dx |
4 swine |
To compare dual-energy computed tomography (CT) with conventional CT for the detection of small-bowel ischemia in an experimental animal model. |
The attenuation difference between ischemic and perfused segments was significantly greater on dual-energy 51-keV CT images than on conventional 120-kVp CT images (mean difference, 91.7 HU vs 47.6 HU; P < .0001). Conspicuity of ischemic segments was significantly greater on dual-energy iodine material-density and 51-keV CT images than on 120-kVp CT images (mean contrast-to-noise ratios, 4.9, 4.3, and 2.1, respectively; P < .0001). Although attenuation differences on dual-energy 65- and 70-keV CT images were not significantly different from those on 120-kVp images (55.0 HU, 45.8 HU, and 47.6 HU, respectively; 65 keV vs 120 kVp, P = .15; 70 keV vs 120 kVp, P = .46), the contrast-to-noise ratio was greater for the 65- and 70-keV images than for the 120-kVp images (4.4, 4.1, and 2.1 respectively; P < .0005). |
3 |
| 41. Lourenco PDM, Rawski R, Mohammed MF, Khosa F, Nicolaou S, McLaughlin P. Dual-Energy CT Iodine Mapping and 40-keV Monoenergetic Applications in the Diagnosis of Acute Bowel Ischemia. AJR Am J Roentgenol. 211(3):564-570, 2018 Sep. |
Observational-Dx |
60 Patients |
To assess the diagnostic performance of iodine-map and monoenergetic (40-keV) images in patients with suspected acute bowel ischemia ABI. |
ABI was observed in 11 patients. For reader A, sensitivity was 63.6% (95% CI, 30.8-89.1%) when interpreting conventional images alone. Sensitivity for detection of ABI increased to 81.8% (95% CI, 48.2-97.7%) and 100% (95% CI, 71.5-100%) when iodine-map and 40-keV images were assessed, respectively. For reader B, no change in sensitivity was seen with either technique, but the number of false-positives were reduced with supplementary iodine-map and 40-keV postprocessed images. Interobserver agreement was fair with conventional images (? = 0.29) but improved to moderate (? = 0.45) and substantial (? = 0.63) with iodine-map and 40-keV images, respectively. Quantitative assessment found significant differences in iodine uptake (1.01 ± 0.55 mg/mL vs 3.04 ± 1.19 mg/mL) and mean attenuation (75.2 ± 38.4 HU vs 163.5 ± 48.9 HU) between nonischemic and ischemic segments, respectively. |
2 |
| 42. Jang KM, Min K, Kim MJ, et al. Diagnostic performance of CT in the detection of intestinal ischemia associated with small-bowel obstruction using maximal attenuation of region of interest. AJR. 2010; 194(4):957-963. |
Observational-Dx |
60 patients |
Retrospective study to assess the diagnostic performance of CT in the detection of intestinal ischemia associated with SBO using the maximal attenuation of a region of interest. Two reviewers were blinded. |
The sensitivity, specificity, PPV, NPV, and accuracy of visual assessment for intestinal ischemia were 91.7% (33/36), 66.7% (16/24), 80.5% (33/41), 84.2% (16/19), and 81.7% (49/60), respectively. The quantification of bowel wall enhancement using the maximal attenuation of a region of interest was a reliable and useful method for the diagnosis of intestinal ischemia and showed good correlation with pathology results. |
2 |
| 43. Kim JH, Ha HK, Kim JK, et al. Usefulness of known computed tomography and clinical criteria for diagnosing strangulation in small-bowel obstruction: analysis of true and false interpretation groups in computed tomography. World J Surg. 2004; 28(1):63-68. |
Observational-Dx |
136 patients; 3 reviewers |
Analysis of CT scans to evaluate the use of clinical criteria in the interpretation of CT scans as a means of improving diagnostic accuracy of CT in strangulated obstruction. |
Diagnostic accuracy of CT criteria for distinguishing simple obstructions from strangulated SBO was 73%-80%. The use of clinical criteria when CT findings are equivocal, may overcome the inherent limitations of CT for diagnosing strangulated obstruction. |
3 |
| 44. Jancelewicz T, Vu LT, Shawo AE, Yeh B, Gasper WJ, Harris HW. Predicting strangulated small bowel obstruction: an old problem revisited. J Gastrointest Surg. 2009; 13(1):93-99. |
Observational-Dx |
192 adult patients |
Retrospective study to determine which clinical indicators in patients with SBO can be used to independently predict the presence of strangulated intestine. |
44 patients had bowel strangulation requiring bowel resection, and 148 had no strangulation. The most significant independent predictor of bowel strangulation was the CT finding of reduced wall enhancement, with a sensitivity and specificity of 56% and 94% [likelihood ratio 9.3]. Regression analysis of multiple preoperative criteria demonstrates that reduced wall enhancement on CT, peritoneal signs, and elevated white blood cells are the only variables independently predictive of bowel strangulation in patients with SBO. |
3 |
| 45. Mallo RD, Salem L, Lalani T, Flum DR. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg. 2005; 9(5):690-694. |
Review/Other-Dx |
15 studies |
Systematic study to describe the diagnostic performance of CT in assessing bowel ischemia and complete obstruction in SBO. |
The aggregated performance characteristics of CT for ischemia in SBO were sensitivity of 83% (range, 63%-100%), specificity of 92% (range, 61%-100%), PPV of 79% (range, 69%-100%), and NPV of 93% (range, 33.3%-100%). The aggregated performance characteristics of CT for complete obstruction were sensitivity of 92% (range, 81%-100%), specificity of 93% (range, 68%-100%), PPV of 91% (range, 84%-100%), and NPV of 93% (range, 76%-100%). Review shows the high sensitivity of CT for ischemia in the setting of SBO and suggests that a CT scan finding of partial SBO is likely to reflect a clinical condition that will resolve without surgical intervention. |
4 |
| 46. Qalbani A, Paushter D, Dachman AH. Multidetector row CT of small bowel obstruction. Radiol Clin North Am. 2007; 45(3):499-512, viii. |
Review/Other-Dx |
N/A |
To review the value of MDCT in the evaluation of SBO and related conditions in adults and emphasize the benefits of advanced CT applications. |
The ability of CT to determine if bowel obstruction is present, to localize the obstructive site, to determine degree of obstruction, to diagnose the presence of closed-loop obstruction, and to identify ischemia or perforation of the involved bowel is well established. |
4 |
| 47. Kato K, Mizunuma K, Sugiyama M, et al. Interobserver agreement on the diagnosis of bowel ischemia: assessment using dynamic computed tomography of small bowel obstruction. Jpn J Radiol. 2010; 28(10):727-732. |
Observational-Dx |
115 patients |
To evaluate the accuracy and interobserver variability of dynamic CT for diagnosis of SBO. |
13 cases were surgically confirmed small bowel ischemia. Sensitivity, specificity, PPV, and NPV for the diagnosis of ischemia were 85%, 96%-97%, 73%-79%, and 97%-98%, respectively, for radiologists and 69%-93%, 93%-95%, 63%-64%, and 96%-99%, respectively, for residents. For agreement in the interpretations of reduced early enhancement of bowel wall, closed loop obstruction, and presence of bowel ischemia, the values were 0.62, 0.71, and 0.80, respectively, between radiologists and 0.57-0.70, 0.63-0.74, and 0.56-0.68, respectively, between radiologists and residents. |
2 |
| 48. Duda JB, Bhatt S, Dogra VS. Utility of CT whirl sign in guiding management of small-bowel obstruction. AJR. 2008; 191(3):743-747. |
Observational-Dx |
453 patients; 194 patients received a diagnosis of SBO |
Retrospective review of patients to examine the relation between the CT whirl sign and outcome among patients with a clinical and radiologic diagnosis of SBO. |
The whirl sign was identified on the CT scans of 40/194 patients. 32/40 patients had SBO necessitating surgery, for a PPV of 80%; 133/154 patients did not need surgery, for a NPV of 86%. 53/194 patients either underwent surgery or died of SBO during conservative therapy. The whirl sign was present on the CT scans of 32/53 patients, for a sensitivity of 60%. 133/141 patients did not need surgery and did not have a whirl sign, for a specificity of 94%. The OR for the whirl sign in predicting the presence of SBO necessitating surgery was 25.3 (95% CI, 10.3-62.3). Results suggest an important role of the whirl sign in assessment of treatment options for patients with clinical and radiologic signs of SBO. |
3 |
| 49. Hwang JY, Lee JK, Lee JE, Baek SY. Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion. Eur Radiol. 2009; 19(10):2425-2431. |
Observational-Dx |
128 patients |
Prospective study to evaluate the value of use of MDCT to predict the need for subsequent surgery in patients with SBO due to adhesion. |
Sensitivities, specificities, PPV and NPV, and risks for the use of MDCT to predict the need for surgery were 100%, 46.1%, 43%, 100%, and 1.9 (1.5 =95% CI =2.2) for a high-grade obstruction; 100%, 23%, 34.5%, 100%, and 1.3 (1.2 =95% CI =1.5) for the presence of a transition zone; and 70.2%, 90.1%, 74.2%, 88.1%, and 7.1 (3.7 =95% CI =13.7) for the presence of an abnormal course of the mesenteric vessels, respectively. The presence of a high degree of SBO and an abnormal vascular course around transition zone are useful indicators on MDCT to predict the need for surgery in patients with an SBO due to adhesion. |
3 |
| 50. O'Daly BJ, Ridgway PF, Keenan N, et al. Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention. Can J Surg. 2009; 52(3):201-206. |
Observational-Dx |
88 consecutive patients: 58 managed conservatively and 30 had surgery |
Retrospective study to determine whether the presence of radiologically detected peritoneal fluid on a CT scan in patients with clinical SBO was associated with an increased need for surgical intervention. |
Peritoneal fluid detected on a CT scan (n=37) was associated more frequently with surgery than conservative management (46% vs 29%, P=0.046, chi(2)). Logistical regression identified peritoneal fluid detected on a CT scan as an independent predictor of surgical intervention (OR 3.0, 95% CI: 1.15-7.84). The presence of peritoneal fluid on a CT scan is an independent predictor of surgical intervention and should alert the clinician that the patient is 3 times more likely to require surgery. |
3 |
| 51. Rocha FG, Theman TA, Matros E, Ledbetter SM, Zinner MJ, Ferzoco SJ. Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography. Arch Surg. 2009; 144(11):1000-1004. |
Observational-Tx |
145 patients with HGSBO |
Retrospective study to determine the natural history and treatment of HGSBO. |
Nonoperative management was associated with a higher recurrence rate (24% vs 9%; P<.005) and shorter time to recurrence (39 days vs 105 days; P<.005) compared with operative intervention. Patients with HGSBO by CT can be managed safely with nonoperative therapy; however, they have a significantly higher rate of recurrence requiring readmission or operation within 5 years. |
2 |
| 52. Zielinski MD, Eiken PW, Bannon MP, et al. Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg. 2010; 34(5):910-919. |
Observational-Dx |
100 consecutive patients |
Retrospective study to identify preoperative risk factors associated with strangulating SBO and to develop a model to predict the need for operative intervention in the presence of an SBO. Hypothesis was that free intraperitoneal fluid on CT is associated with the presence of bowel ischemia and need for exploration. |
Combination of vomiting, no “small bowel feces sign,” free intraperitoneal fluid, and mesenteric edema had a sensitivity of 96%, and a PPV of 90% (OR 16.4, 95% CI: 3.6-75.4) for requiring exploration. Clinical, laboratory, and radiographic factors should all be considered when making a decision about treatment of SBO. The 4 clinical features-intraperitoneal free fluid, mesenteric edema, lack of the “small bowel feces sign,” history of vomiting—are predictive of requiring operative intervention during the patient’s hospital stay and should be factored strongly into the decision-making algorithm for operative vs nonoperative treatment. |
3 |
| 53. Deshmukh SD, Shin DS, Willmann JK, Rosenberg J, Shin L, Jeffrey RB. Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery. Eur Radiol. 2011; 21(5):982-986. |
Observational-Dx |
129 patients |
To identify CT findings predictive of surgical management in non-emergency SBO. |
Degree of obstruction was the only predictor of need for surgery. Whereas, 18.0% of patients with low-grade partial obstruction (n=50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n=77) and 100% of patients with complete obstruction (n=2) required surgery (P=0.004). The small bowel feces sign was inversely predictive of surgery (P=0.018). |
3 |
| 54. Zielinski MD, Eiken PW, Heller SF, et al. Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg. 2011; 212(6):1068-1076. |
Observational-Dx |
100 patients |
To validate and refine the model predictive of the need for exploration in SBO. Study hypothesized that the model would be predictive, would prevent delayed management of strangulation, and would be successfully improved. |
Overall mortality was 8%.29 patients had all 4 clinical features, 22 of whom required operative exploration (concordance index 0.75), confirming the validity of the old model. Intraperitoneal free fluid (OR: 2.6, 95% CI: 1.0 to 6.9) and vomiting (OR: 1.5, 95% CI: 0.5 to 4.5) were not predictive of operative exploration; however, mesenteric edema (OR: 4.2, 95% CI: 1.1 to 15.8) and lack of the small-bowel feces sign were (OR: 3.5, 95% CI: 1.4 to 8.8). Obstipation was associated with the need for exploration (OR: 2.8, 95% CI: 1.2 to 6.6), but absence of colonic gas was not. A new model was equally predictive of the need for exploration: mesenteric edema (OR: 5.6, 95% CI: 1.5 to 20.7), lack of the small-bowel feces sign (OR: 5.1, 95% CI: 1.9 to 13.6), and obstipation (OR: 3.2, 95% CI: 1.2 to 8.3). The concordance index for this new model was 0.77. |
3 |
| 55. Maung AA, Johnson DC, Piper GL, et al. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 73(5 Suppl 4):S362-9, 2012 Nov. |
Review/Other-Tx |
184 studies |
To provide up-to-date evidence-based recommendations for small bowel obstruction (SBO). |
The search identified 53 new articles that were then combined with the 131 studies previously reviewed by the 2007 guidelines. The updated guidelines were then presented at the 2012 annual EAST meeting. |
4 |
| 56. Kulvatunyou N, Pandit V, Moutamn S, et al. A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery. J Trauma Acute Care Surg. 79(3):393-8, 2015 Sep. |
Observational-Dx |
200 Patients |
To identify clinical and computed tomography (CT) predictors of which patients with adhesive small bowel obstruction (ASBO) may need early surgery and to evaluate the utility of the common CT findings. |
During 22 months, we enrolled 200 patients with ASBO. Patients' mean (SD) age was 60 (18) years; 50% were male. Fifty-two patients (26%) underwent surgery. Of those who underwent surgery, the median duration of nonoperative treatment was 1.5 days (interquartile range, 1-2.5 days). In the regression model, we identified no flatus (odds ratio [OR], 3.28; 95% confidence interval [CI], 1.51-7.12; p = 0.003), presence of free fluid on CT (OR, 2.59; 95% CI, 1.13-5.90; p = 0.023), and high-grade obstruction by CT (OR, 2.44; 95% CI, 1.10-5.43; p = 0.028) to be significant predictors for ASBO patients who may need early surgery. |
4 |
| 57. Millet I, Ruyer A, Alili C, et al. Adhesive small-bowel obstruction: value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology. 273(2):425-32, 2014 Nov. |
Observational-Dx |
159 patients |
To identify computed tomographic (CT) findings that are associated with the effectiveness of nonsurgical treatment in patients with adhesive small-bowel obstruction ( SBO small-bowel obstruction ) that was initially treated medically. |
Nonsurgical treatment succeeded in 113 patients (71%) and failed in 46 patients (29%). At univariate analysis, an anterior parietal adhesion, a feces sign, and the lack of a beak sign were associated with successful nonsurgical treatment, whereas two beak signs or more, a whirl sign, a C- or U-shaped appearance of the bowel loop, and a high degree of obstruction were associated with nonsurgical treatment failure. At multivariate analysis, fewer than two beak signs and the presence of an anterior parietal adhesion were independent predictors of the effectiveness of nonsurgical treatment, with odds ratios of 0.27 and 0.11, respectively. |
4 |
| 58. O'Leary EA, Desale SY, Yi WS, et al. Letting the sun set on small bowel obstruction: can a simple risk score tell us when nonoperative care is inappropriate?. Am Surg. 80(6):572-9, 2014 Jun. |
Observational-Dx |
219 patients |
To evaluate the ability of clinical risk factors to predict the failure of nonoperative management of small bowel obstruction (SBO). |
Two hundred nineteen consecutive patients were included. Most patients did not have a prior history of SBO (75%), radiation therapy (92%), or cancer (70%). The majority had undergone previous abdominal or pelvic surgery (82%). Thirty-five per cent of patients ultimately underwent laparotomy. Univariate analysis showed that persistent abdominal pain, abdominal distention, nausea and vomiting, guarding, obstipation, elevated white blood cell count, fever present 48 hours after hospitalization, and high-grade obstruction on computed tomography (CT) scan were significant predictors of the need for surgery. Multivariable analysis revealed that persistent abdominal pain or distention (hazard ratio [HR], 3.04; P = 0.013), both persistent abdominal pain and distention (HR, 4.96; P < 0.001), fever at 48 hours (HR, 3.66; P = 0.038), and CT-determined high-grade obstruction (HR, 3.45; P = 0.017) independently predicted the need for surgery. |
4 |
| 59. Scrima A, Lubner MG, King S, Pankratz J, Kennedy G, Pickhardt PJ. Value of MDCT and Clinical and Laboratory Data for Predicting the Need for Surgical Intervention in Suspected Small-Bowel Obstruction. AJR Am J Roentgenol. 208(4):785-793, 2017 Apr. |
Observational-Dx |
179 adults |
To assess the value of a large panel of clinical and multidetector computed tomography (MDCT) variables in patients with suspected small-bowel obstruction (SBO) for predicting urgent surgical intervention (< 72 hours), bowel ischemia, and bowel resection. |
Among all 179 patients with suspected SBO, 56 (31.3%) underwent surgical intervention within 72 hours, 10 (5.6%) had ischemia at surgery, and nine (5.0%) required small-bowel resection. On univariate analysis, multiple CT findings were highly significant (p < 0.01) for predicting the main surgical outcomes, including degree of obstruction, 5-point radiology likelihood scores, and the presence of a transition point, closed loop, and mesenteric congestion. None of the objective clinical or laboratory variables (including serum lactate level) reached this level of significance. At multivariate analysis, forward stepwise logistic regression with 0.05 significance level cutoff included both degree of obstruction (p < 0.001) and closed loop (p < 0.01), with the presence of a transition point showing a trend toward significance (p = 0.081). |
4 |
| 60. Suri RR, Vora P, Kirby JM, Ruo L. Computed tomography features associated with operative management for nonstrangulating small bowel obstruction. Can J Surg. 57(4):254-9, 2014 Aug. |
Observational-Dx |
288 SBO Patients |
To determine whether specific features on computed tomography (CT) can predict the necessity for operative management of nonstrangulating small bowel obstruction (SBO). |
There were 228 patients with SBO, 63 of whom met our inclusion criteria and had CT scans available for review. Three CT features were frequently associated with operative management and had good concordance between radiologists: complete bowel obstruction, small bowel dilation greater than 4 cm and transition point. Transition point was the only significant factor predictive of operative management for SBO on multivariable logistic regression analysis (OR 19, 95% confidence interval 1.8–201, p = 0.014). |
3 |
| 61. Brown S, Applegate KE, Sandrasegaran K, et al. Fluoroscopic and CT enteroclysis in children: initial experience, technical feasibility, and utility. Pediatr Radiol. 38(5):497-510, 2008 May. |
Observational-Dx |
112 FE and 74 CT enteroclysis studies performed in 175 children |
Retrospective review to evaluate the feasibility, safety, and techniques of FE and CT enteroclysis, and to review their indications and findings in children. |
FE and CT enteroclysis studies were performed most commonly for evaluation of known Crohn disease (FE 38%, CT enteroclysis 29%) and abdominal pain (FE 26%, CT enteroclysis 26%). The findings were normal in 54% of the FE studies and 46% of the CT enteroclysis studies. Most common small bowel diagnoses were Crohn’s disease (FE 34%, CT enteroclysis 28%) and partial SBO (FE 3%, CT enteroclysis 10%). Overall, 14 and 21 patients had surgery as a result of the findings of FE and CT enteroclysis, respectively. FE and CT enteroclysis are safe, feasible, and accurate in depicting small-bowel pathology in children. |
3 |
| 62. Caroline DF, Herlinger H, Laufer I, Kressel HY, Levine MS. Small-bowel enema in the diagnosis of adhesive obstructions. AJR Am J Roentgenol. 142(6):1133-9, 1984 Jun. |
Review/Other-Dx |
60 patients |
To determine the role of small-bowel enema as an alternative technique in diagnosing adhesive obstruction. |
Radiographic diagnosis of adhesive obstruction was correct in 36 (87.8%) of 41 patients in whom a surgical diagnosis could subsequently be made, but an incorrect radiologic diagnosis of obstruction by metastases was made in 5 patients. |
4 |
| 63. Makanjuola D. Computed tomography compared with small bowel enema in clinically equivocal intestinal obstruction. Clin Radiol. 1998; 53(3):203-208. |
Observational-Dx |
49 |
Compare the findings in CT and small bowel enema in clinically equivocal SBO. |
CT: sensitivity 83%, specificity 67%, PPV 94%, NPV 36%. CT superior for detection of the cause of SBO and also for the presence of strangulation. |
3 |
| 64. Anderson CA, Humphrey WT. Contrast radiography in small bowel obstruction: a prospective, randomized trial. Mil Med. 162(11):749-52, 1997 Nov. |
Experimental-Dx |
64 patients |
Prospective randomized trial comparing immediate oral barium contrast studies with abdominal radiographs in patients presenting with signs and symptoms of SBO. |
Barium contrast studies: sensitivity 100% for diagnosing complete obstruction. Radiographs: sensitivity 82%. Among those going to operation, the time from admission to operation was 8.2 hours in the contrast group and 12.4 hours in the plain radiograph group, but this result did not reach statistical significance (P=0.25). Total hospital days were similar between the two groups (8 vs 12 days, P=0.40). There were no complications resulting from the oral administration of barium. Small bowel contrast studies using barium are safe and may shorten the time to operation in patients presenting with signs and symptoms of SBO. |
1 |
| 65. Kendrick ML. Partial small bowel obstruction: clinical issues and recent technical advances. Abdom Imaging. 2009; 34(3):329-334. |
Review/Other-Dx |
N/A |
To review the clinical issues and technical advances of partial SBO. |
No results stated in abstract. |
4 |
| 66. Fidler J. MR imaging of the small bowel. Radiol Clin North Am. 2007; 45(2):317-331. |
Review/Other-Dx |
N/A |
Review MRI of the small bowel with enterography and enteroclysis techniques. Article reviews the advantages, limitations, technique, and indications and the results that have been obtained in evaluating different disease processes. |
Cross-sectional imaging techniques such as CT and MRI have advantages over traditional barium fluoroscopic techniques in their ability to visualize superimposed bowel loops better and to improve visualization of extraluminal findings and complications. |
4 |
| 67. Cronin CG, Lohan DG, Browne AM, Alhajeri AN, Roche C, Murphy JM. MR enterography in the evaluation of small bowel dilation. Clin Radiol. 2009; 64(10):1026-1034. |
Review/Other-Dx |
N/A |
To illustrate the utility of MR enterography in the evaluation of small bowel dilation, whether it be mechanical, functional, or related to infiltrative mural disease. |
MR enterography enables high contrast resolution depiction of the location and cause of bowel obstruction through a combination of predictable luminal distension and multiplanar imaging capabilities. |
4 |
| 68. Walsh DW, Bender GN, Timmons H. Comparison of computed tomography-enteroclysis and traditional computed tomography in the setting of suspected partial small-bowel obstruction. Emerg Radiol. 1998; 5(1):29-37. |
Observational-Dx |
36 patients |
To compare the value of CT enteroclysis with conventional CT in evaluation of suspected partial SBO. |
Overall, CT enteroclysis was more sensitive (89%; 16/18 patients) in diagnosing partial SBO than was traditional CT (50%; 9/18). This was especially evident when considering only patients who presented with a history of malignancy. Of these patients, CT enteroclysis was 100% sensitive (8/8), whereas traditional CT was only 25% sensitive (2/8). The specificity of each modality was almost equivalent (100% for CT enteroclysis vs 94% for CT). Of the patients with malignancy, CT enteroclysis was able to identify tumor involvement of the small bowel with 100% sensitivity (7/7), as compared with only 57% (4/7) for traditional CT. In patients with malignancy, CT enteroclysis was found to be superior to traditional CT in identifying partial SBO and in identifying small bowel intraluminal or intramural disease. The greater strength of CT enteroclysis is its superiority in excluding disease of the small bowel, a desired trait in the management of patients with malignancy. |
3 |
| 69. Matsuo Y. Degree of bowel distension on plain-radiographs--a surgical-radiological study of new criteria in mechanical intestinal obstruction. Jpn J Surg. 1978; 8(3):222-227. |
Review/Other-Dx |
360 cases |
To assess the utility of small bowel diameter/inter-pediculate distance ratio for diagnosing mechanical obstruction. |
Small bowel distension of above 1.0 (ratio) together with obvious gas fluid level usually indicates SBO, while large bowel distension of above 1.5 (ratio) together with obvious gas fluid level usually indicates large bowel obstruction. |
4 |
| 70. Heinberg EM, Finan MA, Chambers RB, Bazzett LB, Kline RC. Postoperative ileus on a gynecologic oncology service--do abdominal X-rays have a role? Gynecol Oncol. 2003; 90(1):158-162. |
Observational-Dx |
84 patients |
Review records of patients to estimate role of abdominal radiographs in management of patients with GI dysfunction after gynecologic surgery. |
At least one set of abdominal X-rays was obtained for 56 (66.7%) patients, of which 24 (42.9%) were considered radiographically diagnostic. A lower preoperative American Society of Anesthesiologists (ASA) physical status score correlated with a greater likelihood of having abdominal films (P=0.005). No single clinical finding correlated with either the decision to obtain films or X-ray diagnosis of ileus or bowel obstruction. Use of any nonsurgical treatment modality was not significantly different for patients who had films vs those who did not. Mean length of hospital stay was significantly prolonged for patients who had abdominal X-rays. 7 patients were subjected to reoperation; however, no association was found between X-ray diagnosis of ileus or bowel obstruction and the need for reoperation. |
3 |
| 71. Ko YT, Lim JH, Lee DH, Lee HW, Lim JW. Small bowel obstruction: sonographic evaluation. Radiology. 1993; 188(3):649-653. |
Observational-Dx |
54 patients |
Retrospective study to compare US with radiographs in detection and characterization of SBO. |
SBO correctly diagnosed: US 89%, radiographs 71%. Level correctly localized: US 76%, radiographs 51%. US may be helpful in confirmation of the presence of obstruction, in determination of the level of obstruction, and in identification of the cause of obstruction. |
3 |
| 72. Czechowski J. Conventional radiography and ultrasonography in the diagnosis of small bowel obstruction and strangulation. Acta Radiol. 1996; 37(2):186-189. |
Observational-Dx |
96 patients |
Patients with clinically acute abdomen were examined by abdominal radiography and US during a period of one year. |
19 cases of mechanical obstruction were observed. Strangulation: positive findings for US 91%, positive findings for radiography 30%. Simple obstruction: 89% for US; 78% for radiography. |
3 |
| 73. Schmutz GR, Benko A, Fournier L, Peron JM, Morel E, Chiche L. Small bowel obstruction: role and contribution of sonography. Eur Radiol. 1997; 7(7):1054-1058. |
Observational-Dx |
123 patients |
Prospective study to determine whether US provides additional clinical information in patients suspected of SBO. |
US confirmed the SBO in 82 cases with 5 false positives, resulting in a specificity of 82.1 %. US examinations were negative in 27 cases with 4 false negatives and a sensitivity of 95 %. The accuracy was 91.7% when the 'gassy' patients were excluded and 81.3% overall. The etiology of the ileus was detected by US in 13 cases of paralytic ileus (54.1 %) and in 57 cases of mechanical ileus (71.4 %). |
3 |
| 74. Wold PB, Fletcher JG, Johnson CD, Sandborn WJ. Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy--feasibility study. Radiology. 2003; 229(1):275-281. |
Observational-Dx |
23 patients |
Comparative study to evaluate two biphasic CT enterography protocols, a noninvasive CT technique with water administered perorally and CT enteroclysis with methylcellulose administered through a nasojejunal tube. |
Arterial phase imaging was noncontributory in 22/23 cases. Noninvasive per-oral water CT enterography protocol had similar accuracy (12/15 cases, 80%) for enabling the detection of active Crohn disease in comparison with CT enteroclysis with nasojejunal tube (7/8, 88%) and fluoroscopic small bowel examination (17/23, 74%). No fistulas were missed with use of either CT technique. Noninvasive per-oral portal venous phase CT enterography with use of water is accurate and feasible. |
2 |
| 75. Taylor MR, Lalani N. Adult small bowel obstruction. [Review]. Academic Emergency Medicine. 20(6):528-44, 2013 Jun. |
Meta-analysis |
22 studies |
To perform a systematic review and meta-analysis of the history, physical examination, and imaging modalities associated with the diagnosis of small bowel obstruction (SBO). The secondary objectives were to identify the prevalence of SBO in prospective ED-based studies of adult abdominal pain and to apply Pauker and Kassirer's threshold approach to clinical decision-making to the diagnosis and management of SBO. |
The prevalence of SBO in the ED was determined to be approximately 2% of all patients who present with abdominal pain. Having a previous history of abdominal surgery, constipation, abnormal bowel sounds, and/or abdominal distention on examination were the best history and physical examination predictors of SBO. X-ray was determined to be the least useful imaging modality for the diagnosis of SBO, with a pooled positive likelihood ratio (+LR) of 1.64 (95% confidence interval [CI] = 1.07 to 2.52). On the other hand, CT and magnetic resonance imaging (MRI) were both quite accurate in diagnosing SBO with +LRs of 3.6 (5- to 10-mm slices, 95% CI = 2.3 to 5.4) and 6.77 (95% CI = 2.13 to 21.55), respectively. Although limited to only a select number of studies, the use of ultrasound (US) was determined to be superior to all other imaging modalities, with a +LR of 14.1 (95% CI = 3.57 to 55.66) and a negative likelihood ratio (-LR) of 0.13 (95% CI = 0.08 to 0.20) for formal scans and a +LR of 9.55 (95% CI = 2.16 to 42.21) and a -LR of 0.04 (95% CI = 0.01 to 0.13) for beside scans. Using the CT results of the meta-analysis for the 5- to 10-mm slice subgroup as well as information on intravenous (IV) contrast reactions and nasogastric (NG) intubation management, the pretest probability threshold for further testing was determined to be 1.5%, and the pretest probability threshold for beginning treatment was determined to be 20.7%. |
Good |
| 76. Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011; 28(8):676-678. |
Observational-Dx |
76 patients |
To compare bedside US and x-ray for the detection of SBO. |
In all, 76 patients were enrolled and evaluated with US for SBO. A total of 33 (43%) were diagnosed as having SBO. Dilated bowel on US had a sensitivity of 91% (95% CI: 75%-98%) and specificity of 84% (95% CI: 69%-93%) for SBO, compared to 27% (95% CI: 14%-46%) and 98% (95% CI: 86%-100%) for decreased bowel peristalsis on US. X-ray had a sensitivity of 46.2% (95% CI: 20.4%-73.9%) and specificity of 66.7% (95% CI: 48.9%-80.9%) for SBO when diagnostic, but was nondiagnostic 36% of the time. |
2 |
| 77. Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol. 1999; 40(4):422-428. |
Observational-Dx |
32 patients |
Prospective study to compare value of radiographs, US, and CT in the evaluation of intestinal obstruction. |
Out of 32 patients, 30 had mechanical intestinal obstruction (22 had SBO and 8 had large bowel obstruction). Of the remaining 2 patients, 1 had adynamic ileus and the other had a mesenteric cyst. CT had high sensitivity (93%), specificity (100%) and accuracy (94%) in diagnosing the presence of obstruction. The comparable sensitivity, specificity and accuracy were, respectively; 83%, 100% and 84% for US and 77%, 50% and 75% for plain radiography. The level of obstruction was correctly predicted in 93% on CT, in 70% on US and in 60% on plain films. CT was superior (87%) to both US (23%) and plain radiography (7%) in determining the etiology of obstruction. |
2 |
| 78. Pracros JP, Sann L, Genin G, et al. Ultrasound diagnosis of midgut volvulus: the "whirlpool" sign. Pediatr Radiol. 1992; 22(1):18-20. |
Review/Other-Dx |
24 patients |
Present US findings in patients with proved complicated midgut malrotation: volvulus in 18 and occlusive Ladd’s bands in 6. All 24 patients have had US prior to surgery. |
The US “whirlpool” pattern of the superior mesenteric vein and mesentery around the superior mesenteric artery was detected in 15/18 patients with midgut volvulus, and was best seen using Doppler color. |
4 |
| 79. Ikeda H, Matsuyama S, Suzuki N, Takahashi A, Kuroiwa M, Hatakeyama S. Small bowel obstruction in children: review of 10 years experience. Acta Paediatr Jpn. 1993; 35(6):504-507. |
Review/Other-Dx |
32 patients |
Review of cause of post-neonate SBO, and methods of detection. |
Intussusception (most frequent cause of obstruction) was seen in 17 patients (53.1%). Causative lesions were identified in 5 patients, (4 ileal duplication cysts in four and one Meckel’s diverticulum). Incarcerated inguinal hernia and mesenteric cysts resulted in bowel obstruction in 6 and 3 patients, respectively. US was useful in differential diagnosis. |
4 |
| 80. Maglinte DD, Gage SN, Harmon BH, et al. Obstruction of the small intestine: accuracy and role of CT in diagnosis. Radiology. 188(1):61-4, 1993 Jul. |
Observational-Dx |
55 Patients |
To evaluate the reliability of abdominal computed tomography (CT) in the assessment of varying degrees of small bowel obstruction (SBO) by using results at enteroclysis and clinical outcome as standards of reference. |
A blinded retrospective analysis was performed of the studies of 55 patients who underwent both CT and enteroclysis in the course of assessment for suspected SBO. Nine patients had no obstruction, 40 patients had obstruction due to adhesions, and six patients had tumor-related obstruction. CT results were used to identify correctly 63% (29 of 46) of those who had SBO and 78% (seven of nine) of the patients who did not. The overall accuracy of the CT interpretations to help establish diagnosis was 65% (36 of 55). When obstructions were classified into low- and high-grade partial obstruction, CT results could be used to identify correctly 81% (17 of 21) of high-grade SBOs and 48% (12 of 25) of low-grade SBOs. |
4 |
| 81. Khurana B, Ledbetter S, McTavish J, Wiesner W, Ros PR. Bowel obstruction revealed by multidetector CT. [Review] [8 refs]. AJR Am J Roentgenol. 178(5):1139-44, 2002 May. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 82. Boudiaf M, Jaff A, Soyer P, Bouhnik Y, Hamzi L, Rymer R. Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients. Radiology. 2004; 233(2):338-344. |
Observational-Dx |
107 consecutive patients |
To prospectively evaluate MDCT enteroclysis for the depiction of small bowel disease. |
Sensitivity, specificity, accuracy, PPV, and NPV of MDCT enteroclysis were 100%, 95%, 97%, 94%, and 100%, respectively. MDCT enteroclysis allows depiction of a variety small bowel diseases in patients suspected of having small bowel disease. |
2 |
| 83. Engin G. Computed tomography enteroclysis in the diagnosis of intestinal diseases. J Comput Assist Tomogr. 2008; 32(1):9-16. |
Review/Other-Dx |
N/A |
Review the technique and clinical applications of CT enteroclysis; its advantages and limitations compared with the other imaging techniques and capsule endoscopy are discussed. |
CT enteroclysis is becoming the first-line modality for the evaluation of advanced and complicated small bowel Crohn’s disease. CT enteroclysis can also become an important complementary imaging technique to capsule endoscopy in the assessment of small bowel neoplasms and occult GI hemorrhage. |
4 |
| 84. Kohli MD, Maglinte DD. CT enteroclysis in incomplete small bowel obstruction. Abdom Imaging. 2009; 34(3):321-327. |
Review/Other-Dx |
N/A |
Review the role of CT enteroclysis in the evaluation of patients with suspected SBO. The technique of examination is described and an overview of its clinical applications and imaging controversy are presented. |
Despite losing ground in the clinical evaluation of small bowel disease to recent advances in wireless capsule endoscopy and double balloon enteroscopy CT enteroclysis retains benefit in the evaluation of small bowel obstruction due to the ability to challenge bowel wall distensibility and uncover sub-clinical or low-grade obstruction. Polyps, masses, and inflammatory changes are readily recognized or excluded in the setting of luminal distention of a long tubular structure with an unpredictable course. Direct infusion into the small bowel has several advantages over passive oral ingestion of contrast regardless of the volume. |
4 |
| 85. Hong SS, Kim AY, Kwon SB, Kim PN, Lee MG, Ha HK. Three-dimensional CT enterography using oral gastrografin in patients with small bowel obstruction: comparison with axial CT images or fluoroscopic findings. Abdom Imaging. 2010; 35(5):556-562. |
Observational-Dx |
18 patients |
To evaluate the feasibility of 3D CT enterography using oral gastrografin in patients with SBO, focusing on improving diagnostic performance as compared with the use of axial CT images and fluoroscopic findings. |
All patients (100%) well tolerated the administration of oral gastrografin. The use of 3D CT enterography significantly improved diagnostic confidence for the interpretation of the level, cause of SBO, and the assessment of the interpretability of each image as compared with the use of axial CT images (P<0.05). 3D CT enterography was superior as compared to fluoroscopic examination (P<0.05). |
2 |
| 86. Roediger WE, Marshall VC, Roberts S. Value of small bowel enema in incomplete intestinal obstruction. Aust N Z J Surg. 1982; 52(5):507-509. |
Review/Other-Dx |
11 patients |
To assess usefulness of small bowel enema in patients with suspected partial SBO. |
In 1 patient intubation of the jejunum was unsuccessful. In 6 patients the suspected obstruction was confirmed and information obtained about the site of obstruction. The small bowel enema X-ray examination was normal in 3 patients and subsequent clinical outcome was uneventful. In 1 patient, with normal findings on small bowel enema X-ray examination, acute obstruction developed after 2 days, necessitating operation. |
4 |
| 87. He B, Gu J, Huang S, et al. Diagnostic performance of multi-slice CT angiography combined with enterography for small bowel obstruction and intestinal ischaemia. Journal of Medical Imaging & Radiation Oncology. 61(1):40-47, 2017 Feb. |
Observational-Dx |
57 SBO Patients |
To evaluate the diagnostic performance of multi-slice CT angiography combined with enterography in determining the cause and location of obstruction as well as intestinal ischaemia in patients with small bowel obstruction (SBO). |
Multi-slice CT angiography and enterography indicated that the cause of SBO in three patients was misjudged, suggesting a diagnostic accuracy of 94.7%. In one patient the level of obstruction was incorrect, demonstrating a diagnostic accuracy of 98.2%. Based on the results of the receiver operating characteristic (ROC) curve analysis, the diagnostic criterion for ischaemic SBO was at least two of the four CT signs (circumferential bowel wall thickening, reduced enhancement of the intestinal wall, mesenteric oedema and mesenteric vascular engorgement). The criterion yielded a sensitivity of 94.4%, a specificity of 92.3%, a positive predicted value of 85.0% and a negative predicted value of 97.3%, and the area under curve (AUC) was 0.92 (95% CI, 0.85-0.99). |
4 |
| 88. Maglinte DT, Herlinger H, Turner WW, Kelvin FM. Radiologic management of small bowel obstruction: a practical approach. Emerg Radiol. 1994; 1(3):138-149. |
Review/Other-Dx |
N/A |
Review radiographs, contrast studies, and cross-sectional imaging for SBO. Roles of enteroclysis and CT are discussed. |
Begin with radiographs; decision as to enteroclysis vs CT depends on clinical factors. |
4 |
| 89. Maglinte DD, Burney BT, Miller RE. Lesions missed on small-bowel follow-through: analysis and recommendations. Radiology. 1982; 144(4):737-739. |
Review/Other-Dx |
42 small bowel lesions |
To analyze potential sources of error accounting for missed pathology on small-bowel follow-through. |
30 lesions (71%) were not seen in retrospect; this was attributed to technical inadequacies. 12 lesions (29%) were seen in retrospect. Of these, 2 (17%) of the lesions had been missed originally because of perceptive errors, 7 (58%) because of combined perceptive and technical errors, and 3 (25%) because of interpretive errors. |
4 |
| 90. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
