Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction?

BACKGROUND

Small-bowel obstruction (SBO) is a common dilemma faced by general surgeons. A timely and accurate diagnosis is crucial, based on history, physical examination, and radiographic studies. A computed tomography (CT) scan has become an increasingly common diagnostic modality. The aim of this study was to define a set of CT criteria that may help determine whether a patient would require operative intervention.

METHODS

A retrospective chart review was performed over an 18-month period. Patients diagnosed with SBO or partial SBO (PSBO) who had a CT scan performed were included. CT scans were then reviewed independently by a staff radiologist blinded to the clinical outcome. A scoring system based on 7 radiographic criteria was then developed. Statistical analysis was performed on the data.

RESULTS

From March 1, 2004, to August 30, 2005, 96 patients were found to have the diagnosis of SBO or PSBO and a documented CT scan. Seventy-four patients had undergone prior intra-abdominal procedures. Fifty-five percent were taken to the operating room (OR) over an average of 1.9 days (range 1-12 days). Seventy-nine percent of these patients went to the OR within the first 24 hours. Lysis of adhesions was performed in 38%, small bowel was resected in 47%, and incarcerated ventral hernias were found in 11%. Ischemic bowel was found in 11% of the cases. The CT scoring system was then correlated with the actual treatment. A score of 8 or higher predicted the need for surgery 75% of the time. When looking at the criteria individually, patients with a CT reading of complete obstruction, dilated small bowel, or free fluid were operated on 77%, 66%, and 65% of the time, respectively.

CONCLUSION

A CT scoring system can successfully predict the need for surgery 75% of the time. Likewise, specific criteria, when present in combination, can predict the need for operative intervention in 79% of cases with SBO.