Abstracts of 33rd RSP Conference (27-29th October 2017) Karachi, Pakistan

Maseeh uz Zaman


Rabail Raza, Muhammad Ismail Alvi, Anwar Ahmed, Raza Sayani.
Department of Radiology, Aga Khan University, Karachi, Pakistan
Email: rabail.raza@aku.edu
Assessment of bowel wall enhancement for the diagnosis of
intestinal ischemia in patients with small bowel obstruction
value of adding unenhanced ct to contrast-enhanced:
Retrospective review
ABSTRACT: Acute obstruction of the small bowel is a frequent reason for
presentation to the emergency department. Causes of obstruction are multiple
(tumorous, inflammatory, postoperative, iatrogenous, metabolic, or congenital),
but the clinical presentation is usually nonspecific. Recent reports have shown
the usefulness of CT in the diagnosis of mesenteric ischemia, especially in
the context of acute bowel obstruction. Our objective was to determine whether
adding unenhanced CT to contrast-enhanced CT improved the diagnostic
performance of decreased bowel wall enhancement as a sign of ischemia in
patients with mechanical SBO.
METHODS: All patients seen over a 3-year period with a CT diagnosis of
small-bowel obstruction were included. Images were interpreted by experienced
gastrointestinal radiologist. Attention was focused on the presence of the
following signs of strangulation and ischemia: reduced enhancement of the
small-bowel wall, mural thickening, mesenteric fluid, congestion of small
mesenteric veins, and ascites. A diagnosis of ischemia was made if enhancement
of the bowel wall was reduced or if at least two of the other signs were found.
RESULTS: A diagnosis of ischemia was made at surgery in 24 patients. CT
diagnosis was correct in 23 patients (96% sensitivity). There were nine falsepositive
diagnoses (93% specificity). 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%.
CONCLUSION: Adding unenhanced CT to contrast-enhanced CT improved
the sensitivity and diagnostic confidence in the diagnosis of ischemia, a
complication of mechanical SBO, on the basis of decreased bowel wall
enhancement. Our results support performing routine unenhanced imaging
before contrast-enhanced imaging in patients who are undergoing CT to

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