DOI: https://dx.doi.org/10.18203/2349-2902.isj20215129
Published: 2021-12-28

Computed tomography in intestinal obstruction: a tertiary care perspective from Northern India

Varun Dogra, Shyam Gupta, Ishfaq Ahmad Gilkar, Silvi Sandhu

Abstract


Background: Intestinal obstruction is a very common surgical emergency faced today in surgical ERs (emergency rooms) all around the globe. With the advent of newer technology, management of intestinal obstruction has changed significantly. Today computed tomography (CT) employs both intravenous as well as oral contrast for determining the cause and the level of obstruction. It also gives additional information regarding any malignancy causing the obstruction, its staging and status of vessels. Thus, a surgeon can go in the procedure with a plan already in mind which can be discussed in detail with experienced surgeons beforehand.

Methods: This was a prospective observational study that was done in department of surgery at GMC Jammu over a period of two years. Patients of intestinal obstruction who presented to our department were enrolled in this study. They were subjected to a contrast enhanced CT after due preparation and managed accordingly. Data was recorded in a tabulated fashion and evaluated.

Results: After implementing the exclusion criteria’s, a total of 163 patients were included in this study, majority being males in the age group of 20-40 years. Major cause of intestinal obstruction was attributed to post-operative adhesions followed by band obstruction due to various cause. CT findings were seen to be quite significant in evaluation and management of intestinal obstruction. About 30 % of the patients enrolled in our study were treated conservatively while 70 % required operative intervention in form of exploratory laparotomy.

Conclusions: Computed tomography is widely available now a days at a cheaper cost. It greatly increases the armamentarium of the surgeon in dealing with this condition. A lot many cases today are dealt conservatively due to high utilisation of CT scan. It also helps the surgeon to preoperatively plan a proper surgical approach


Keywords


Intestinal obstruction, CT, Obturator hernia

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References


Mucha P. Small intestinal obstruction. Surg Clin North Am. 1987;67:597.

Wright HK, O'Brien JJ, Tilson MD. Water absorption in experimental closed segment obstruction of the ileum in man. Am J Surg. 1971;121:96.

Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg. 2000;87:1240.

Sekhon G, Vohra A, Singh K, Mittal A, Singal S, Singal R. Role of Multidetector Computed Tomography in the Evaluation of Intestinal Obstruction. Int J Sci Stud. 2016;4(8):109-14.

Baid G, Dawan ML, Parmar A. Role of CT scan in evaluation and management of intestinal obstruction. Int Surg J. 2017;4:2257-61.

Bull J. The History of Computed Tomography. In: Caillé JM., Salamon G. (eds) Computerized Tomography. Springer, Berlin, Heidelberg. 1980.

Gupta R. MDCT in Bowel Obstruction. J Clin Diagnostic Res. 2016;10(11):TC01-4.

Grassi R, Romagno S, Pinto A, Romano L. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004;50(1):30-6.

Paulson EK. Acute cholecystitis: CT findings. Semin Ultrasound CT MR. 2000;21(1):56.

Tseng CW, Chen CC, Chen TS, Chang FY, Lin HC, Lee SD. Can computed tomography with coronal reconstruction improve the diagnosis of choledocholithiasis? J Gastroenterol Hepatol. 2008;23(10):1586.

Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262(3):751-64.

Di S, S CF, Galati M, Smerieri N, Biffl WL, Ansaloni L et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the World Society of Emergency Surgery ASBO Working Group. World J Emerg Surg. 2013;8(1):42.

Oliva IB, Davarpanah AH, Rybicki FJ, Desjardins B, Flamm SD, Francois CJ et al. ACR Appropriateness Criteria imaging of mesenteric ischemia. Abdom Imaging. 2013;38(4):714-9.

Garst GC, Moore EE, Banerjee MN, Leopold DK, Burlew CC, Bensard DD et al. Acute appendicitis: a disease severity score for the acute care surgeon. J Trauma Acute Care Surg. 2013;74(1):32-6.

Balfe DM, Levine MS, Ralls PW, Bree RL, DJ DS, Glick SN et al. Evaluation of left lower quadrant pain. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000;215(1):167-71.

Barger RL Jr, Nandalur KR. Diagnostic performance of magnetic resonance imaging in the detection of appendicitis in adults: a meta-analysis. Acad Radiol. 2010;17(10):1211-6.

Chang WC, Ko KH, Lin CS, Hsu HH, Tsai SH, Fan HL et al. Features on MDCT that predict surgery in patients with adhesive-related small bowel obstruction. PLoS One. 2014;9:e89804.

Saini DK, Chaudhary P, Durga CK, Saini K. Role of multi slice computed tomography in evaluation and management of intestinal obstruction. Clin Pract. 2013;3:e20.

Malik AM, Shah M, Pathan R, Sufi K. Pattern of acute intestinal obstruction: Is there a change in the underlying etiology? Saudi J Gastroenterol. 2010;16:4-85.

Delabrousse E, Lubrano J, Jehl J, Morati P, Rouget C, Mantion GA et al. Smallbowel obstruction from adhesive bands and matted adhesions: CT differentiation. AJR Am J Roentgenol. 2009;192(3):693-7.

Osada H, Watanabe W, Ohno H, Okada T, Yanagita H, Takahashi et al. Multidetector CT appearance of adhesion-induced small bowel obstructions: matted adhesions versus single adhesive bands. Jpn J Radiol. 2012;30(9):706.

Angelelli G, Moschetta M, Binetti F, Cosmo T, Stabile Ianora AA. Prognostic value of MDCT in malignant large-bowel obstructions. Radiol Med. 2010;115(5):747-57.

Dimitrios M, Paramjeet S, Rajeev J, Cayten C. Gene: Colonic Wall Thickening on Computed Tomography Scan and Clinical Correlation. Does It Suggest the Presence of an Underlying Neoplasia? Am Surgeon. 2006;72(3):269-71.

Mandarry MT, Zeng SB, Wei ZQ, Zhang C, Wang ZW. Obturator hernia-A condition seldom thought of and hence seldom sought. Int J Colorectal Dis. 2012;27:133-41.