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Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process

  • Special Section: Intestinal ischemia
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Abstract

The objective of this article is to assess the computed tomography (CT) findings of small bowel obstruction (SBO) complicated by ischemia. SBO is a frequent clinical entity characterized by high morbidity and mortality. The radiologic aim is not just to diagnose the obstruction itself but to rule out the presence of complications related to SBO. This is crucial for differentiating which patients can be safely treated non-operatively from the ones who may need an urgent surgical approach. The main complication of SBO is intestinal ischemia. In the emergency setting, CT imaging is the modality of choice for SBO because of its ability to assess the bowel wall, the supporting mesentery and peritoneal cavity all in one. On the other hand, the radiologist who documents an intestinal ischemia should think about SBO as possible cause. In this case, the main finding which helps the radiologist in the identification of SBO is the presence of multiple and packed valvulae conniventes in the dilated bowel wall and the “transition zone” that indicates the passage between compressed and decompressed small bowel, otherwise the localization of the obstruction cause. Once the site of obstruction has been recognized, the other issue is to assess the cause of obstruction, considering that the most common cause of SBO remains “unidentified” and related to intra-abdominal adhesions. After that, the following most important point is to rule out the presence of an ischemic bowel and mesenteric changes associated to SBO. CT signs of bowel ischemia include reduced or increased bowel wall enhancement, mesenteric edema or engorgement, fluid or free air in the peritoneal cavity. This condition usually leads to an urgent laparotomy and, in some cases, to a surgical resection.

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Authors and Affiliations

  1. Department of Radiology, Pineta Grande Hospital, Via Domitiana KM 30, 81030, Castel Volturno, Italy

    Mariano Scaglione & Ettore Laccetti

  2. Teeside University & Department of Radiology, James Cook University Hospital, Marton Rd, Middlesbrough, TS4 3BW, UK

    Mariano Scaglione

  3. Department of Radiology, “San Camillo Forlannini” Hospital, Circonvallazione Gianicolense, 87, 00100, Rome, Italy

    Michele Galluzzo & Margherita Trinci

  4. Department of Radiology, University of Rome “Campus Bio-medico”, Via Alvaro del Portillo, 21, 00128, Rome, Italy

    Domiziana Santucci, Laura Messina, Eliodoro Faiella & Bruno Beomonte Zobel

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Scaglione, M., Galluzzo, M., Santucci, D. et al. Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process. Abdom Radiol 47, 1541–1555 (2022). https://doi.org/10.1007/s00261-020-02800-3

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