Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, Hôpital Jean Minjoz, 3 Boulevard Fleming, 25030, Besançon, France.
EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France.
Eur Radiol. 2022 Oct;32(10):6646-6657. doi: 10.1007/s00330-022-08951-9. Epub 2022 Jun 28.
The purpose of this study was to identify the preoperative CT features that are associated with inadvertent enterotomy (IE) during adhesive small bowel obstruction (ASBO) surgery.
From January 2015 to December 2019, all patients with ASBO who underwent an abdominal CT were reviewed. Abdominal CT were retrospectively reviewed by two radiologists with a consensus read in case of disagreement. IE during ASBO surgery was retrospectively recorded. Univariate and multivariate analyses of CT features associated with IE were performed and a simple CT score was built to stratify the risk of IE. This score was validated in an independent retrospective cohort. Abdominal CT of the validation cohort was reviewed by a third independent reader.
Among the 368 patients with ASBO during the study period, 169 were surgically treated, including 129 ASBO for single adhesive band and 40 for matted adhesions. Among these, there were 47 IE. By multivariate analysis, angulation of the transitional zone (OR = 4.19, 95% CI [1.10-18.09]), diffuse intestinal adhesions (OR = 4.87, 95% CI [1.37-19.76]), a fat notch sign (OR = 0.32, 95% CI [0.12-0.85]), and mesenteric haziness (OR = 0.13, 95% CI [0.03-0.48]) were independently associated with inadvertent enterotomy occurrence. The simple CT score built to stratify risk of IE displayed an AUC of 0.85 (95% CI [0.80-0.90]) in the study sample and 0.88 (95% CI [0.80-0.96]) in the validation cohort.
A simple preoperative CT score is able to inform the surgeon about a high risk of IE and therefore influence the surgical procedure.
• In this retrospective study of 169 patients undergoing abdominal surgery for adhesive small bowel obstruction, 47 (28%) inadvertent enterotomy occurred. • A simple preoperative CT score enables accurate stratification of inadvertent enterotomy risk (area under the curve 0.85). • By multivariable analysis, diffuse intestinal adhesions and angulation of the transitional zone were predictive of inadvertent enterotomy occurrence.
本研究旨在确定与粘连性小肠梗阻（ASBO）手术期间意外肠切开（IE）相关的术前 CT 特征。
回顾性分析 2015 年 1 月至 2019 年 12 月期间所有接受 ASBO 腹部 CT 的患者。如果意见不一致，由两名放射科医生进行共识读片。回顾性记录 ASBO 手术期间的 IE。对与 IE 相关的 CT 特征进行单变量和多变量分析，并建立简单 CT 评分以分层 IE 风险。该评分在独立的回顾性队列中得到验证。验证队列的腹部 CT 由第三位独立读者进行评估。
在研究期间，有 368 例 ASBO 患者接受了手术治疗，其中 129 例为单一粘连带粘连，40 例为粘连。其中，有 47 例 IE。多变量分析显示，过渡区角度（OR=4.19，95%CI[1.10-18.09]）、弥漫性肠粘连（OR=4.87，95%CI[1.37-19.76]）、脂肪切迹征（OR=0.32，95%CI[0.12-0.85]）和肠系膜混浊（OR=0.13，95%CI[0.03-0.48]）与意外肠切开的发生独立相关。为分层 IE 风险而建立的简单 CT 评分在研究样本中的 AUC 为 0.85（95%CI[0.80-0.90]），在验证队列中的 AUC 为 0.88（95%CI[0.80-0.96]）。
术前简单 CT 评分可告知外科医生 IE 发生的高风险，从而影响手术过程。
在这项对 169 例因粘连性小肠梗阻行腹部手术的患者的回顾性研究中，有 47 例（28%）发生了意外肠切开。
术前简单 CT 评分可准确分层意外肠切开风险（曲线下面积 0.85）。
多变量分析显示，弥漫性肠粘连和过渡区角度是意外肠切开发生的预测因素。
