The Role of Contrast- Enchased Computer Tomography in the Management of Intestinal Obstruction

Lazarova, Ana and Gligorievski, Antonio (2021) The Role of Contrast- Enchased Computer Tomography in the Management of Intestinal Obstruction. CPQ Medicine, 12 (1). pp. 2-14.

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Abstract

Introduction: Intestinal obstruction is a condition in which intestine is obstructed because of any mechanical or non-mechanical reasons. It accounts for 20% of all surgical admissions for acute abdomen. Computed tomography (CT) is currently the exam of choice for bowel obstruction because has higher specificity in reporting the etiology, site and grade of obstruction, and the presence of bowel ischemia, affecting the surgical decision.
Objective: To determine the sensitivity and specificity of contrast-enchased CT for diagnosing the small and large bowel obstruction.
Material and methods: This is prospective study which includes 100 patients diagnosed with bowel obstruction in the period from January 2016 to July 2020 in the University Clinic for Surgery Disease St.Naum Ohridski Skopje. All of the patients were with clinic presentation of acute abdomen. Primary conventional X- ray on abdomen was done and bowel distention with developed air-fluid levels was found. This was an indication for CT so the reason for bowel obstruction to be found as well as the level, site and grade of obstruction.76 from 100 patients underwent operative treatment whereas 14 patients were treated conservatively and with nasogastric tube decompression.Тhe results of surgical treatment in resolving intestinal obstruction and the finding for etiology were taken as the gold standard in evaluating the accuracy of CT in detecting the causes of intestinal obstruction.
Results: This study included a 100 patients aged from 44 to 81 years.55 from the patients were male and 45 female .60 from the patients had small bowel obstruction and 30 patents had large bowel obstruction , whereas in 10 patients there was bowel obstruction on the small and large intestine in the same time. In 39 patients small bowel obstruction was caused by adhesive bends and in that case CT scan made prediction for that reason made on exclusion. In two cases ileus was as a result of pseudomembranous colitis, one as small bowel obstruction and one was small and large bowel obstruction. There were 3 patients with acute diverticulitis on sigmoid part of the colon. In one case it was small bowel obstruction and in two patients there were small and secondary large bowel obstruction. One case was presented with peritoneal carcinomatosis as a reason for bowel obstruction. Seven from the patients with bowel obstruction were with intestinal ischemia as a result of mesenteric thrombosis. Five of them were only with small bowel obstruction a two were with small primary and then developed large bowel obstruction.11 patients presented with bowel obstruction as a result of herniation. In two patients complications from Morbus Chron were the reason for small bowel obstruction. There were 30 patients present with large bowel obstruction. The main cause of it in 24 patients was neoinfiltrative process in the wall of the bowel. In 6 patients the reason for large bowel obstruction was sigmoid volvulus. CT is more sensitive than radiographs and its ability to demonstrate the cause of bowel obstruction is around 80% of the cases.
Conclusion: This study is a clear indication of the importance of contrasts enhanced CT in the evaluation of intestinal obstruction. High accuracy in detecting the etiology of intestinal obstruction makes it the most important diagnostic method for adequate resolution of intestinal obstruction.

Item Type:	Article
Subjects:	Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Medical Science
Depositing User:	Antonio Gligorievski
Date Deposited:	16 Jun 2021 05:51
Last Modified:	16 Jun 2021 05:51
URI:	https://eprints.ugd.edu.mk/id/eprint/28182

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