Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Eur Radiol. 2021 Mar;31(3):1597-1607. doi: 10.1007/s00330-020-07406-3. Epub 2020 Oct 31.
To clarify CT findings that predict outcome of conservative treatment in patients with non-strangulated adhesive small bowel obstruction (SBO).
Unenhanced and contrast-enhanced abdominopelvic CT studies in 189 patients with adhesive SBO who had initial conservative treatment were reviewed. The CT findings included transition zone, beak signs, maximum bowel diameter, bowel diameter ratio, decreased bowel wall enhancement, increased unenhanced bowel wall attenuation, anterior parietal adhesion, bowel wall thickening, closed-loop obstruction, small bowel feces sign, whirl sign, mesenteric haziness, mesenteric, peritoneal fluid, and submucosal edema. These findings were statistically compared according to the success or failure of treatment.
Conservative treatment succeeded in 144 patients (76.2%) and failed in 45 patients (23.8%). At multivariate analysis, the lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid were independent findings predicting failure of conservative treatment, with odds ratios of 5.23, 5.5, 13.55, and 4.89, respectively. The presence of all significant findings showed a high specificity of 97.2% with positive likelihood ratio of 8.8. If CT scans showed none of the three significant findings, the negative predictive value was 97.6% and negative likelihood ratio was 0.08.
The lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid are independent CT findings predicting the failure of conservative treatment in patients with non-strangulated adhesive SBO. The combination of all CT findings suggests the need for surgery; absence of two or all CT findings should suggest an attempt for conservative treatment.
• To minimize delayed operation, it is important to identify non-strangulated adhesive small bowel obstruction patients in whom initial conservative treatment is likely to fail. • The lack of small bowel feces sign, the presence of mesenteric haziness, and a moderate amount of mesenteric fluid are independent factors predicting the failure of conservative treatment in patients with non-strangulated adhesive small bowel obstruction. • The combination of all three CT findings suggests the need for surgery; absence of two or all three CT findings should suggest an attempt for conservative treatment.
阐明可预测非绞窄性粘连性小肠梗阻（SBO）患者保守治疗结局的 CT 表现。
回顾了 189 例接受初始保守治疗的粘连性 SBO 患者的增强和非增强腹盆腔 CT 研究。CT 表现包括过渡区、喙征、最大肠径、肠径比、肠壁增强减弱、肠壁未增强衰减增加、前壁粘连、肠壁增厚、闭袢性梗阻、小肠粪便征、漩涡征、肠系膜混浊、肠系膜积液和黏膜下水肿。根据治疗的成功或失败，对这些发现进行了统计学比较。
144 例（76.2%）患者保守治疗成功，45 例（23.8%）患者失败。多变量分析显示，缺乏小肠粪便征、局灶性、弥漫性肠系膜混浊和中等量肠系膜积液是独立预测保守治疗失败的发现，比值比分别为 5.23、5.5、13.55 和 4.89。所有显著发现的存在具有 97.2%的高特异性，阳性似然比为 8.8。如果 CT 扫描没有显示出这三种显著发现中的任何一种，阴性预测值为 97.6%，阴性似然比为 0.08。
缺乏小肠粪便征、局灶性、弥漫性肠系膜混浊和中等量肠系膜积液是预测非绞窄性粘连性 SBO 患者保守治疗失败的独立 CT 表现。所有 CT 表现的组合提示需要手术；如果没有两种或所有三种 CT 表现，则应尝试保守治疗。
为了尽量减少手术延迟，识别初始保守治疗可能失败的非绞窄性粘连性小肠梗阻患者非常重要。
缺乏小肠粪便征、肠系膜混浊存在和中等量肠系膜积液是预测非绞窄性粘连性小肠梗阻患者保守治疗失败的独立因素。
所有三种 CT 表现的组合提示需要手术；如果没有两种或所有三种 CT 表现，则应尝试保守治疗。
