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High-Density Free Fluid on Computed Tomography: a Predictor of Surgical Intervention in Patients with Adhesive Small Bowel Obstruction

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Patients with adhesive small bowel obstruction (ASBO) often develop intraabdominal free fluid (IFF). While IFF is a finding on abdominopelvic computed tomography (CT) associated with the need for surgical intervention, many patients with IFF can be still managed non-operatively. A previous study suggested that a higher red blood cell count of IFF is highly predictive of strangulated ASBO. We hypothesized that radiodensity in IFF (Hounsfield unit (HU)) on CT would predict the need for surgical intervention.

Study Design

Patients with clinicoradiological evidence of ASBO between January 2009 and December 2013 were identified. In patients with IFF > 3 cm2 identified on CT, the HU was measured in the largest pocket of IFF. A sensitivity analysis was performed to determine a high-density HU threshold. The HU of patients who underwent therapeutic laparotomy was compared with those successfully discharged with non-operative management.

Results

A total of 318 patients with ASBO (median age 52 years, 56.0 % male) were identified. Of 111 patients who had IFF on CT, 55.9 % underwent therapeutic laparotomy and 15.3 % required bowel resection. Radiodensity of IFF in the operative group was significantly higher than that in the non-operative group (18.2 vs. 7.0 HU, p < 0.01). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of high-density IFF (>10 HU) to predict the need for surgical intervention were 83.9, 65.3, 75.4, 76.2, and 75.6 %, respectively.

Conclusions

High-density IFF on CT was significantly associated with the need for surgical intervention in patients with ASBO. Prospective study to validate the predictive value of high-density IFF on CT will be warranted.

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Acknowledgments

No internal and external financial support was used for this study.

Authors’ Contributions

Study concept and design: Matsushima, Inaba, Dollbaum, Herr, Strumwasser, Demetriades

Data collection, analysis, and interpretation: Matsushima, Dollbaum, Cheng, Khan, Asturias, Dilektasli

Writing: Matsushima, Dollbaum, Cheng

Critical revision: Inaba, Khan, Herr, Strumwasser, Asturias, Dilektasli, Demetriades

All the authors approved the final version to be published.

All the authors are accountable for all aspects of the work.

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Authors and Affiliations

  1. Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA

    Kazuhide Matsushima, Kenji Inaba, Ryan Dollbaum, Vincent Cheng, Moazzam Khan, Aaron Strumwasser, Sabrina Asturias, Evren Dilektasli & Demetrios Demetriades

  2. Department of Radiology, University of Southern California, Los Angeles, CA, USA

    Keith Herr

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  1. Kazuhide Matsushima
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Correspondence to Kazuhide Matsushima.

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Matsushima, K., Inaba, K., Dollbaum, R. et al. High-Density Free Fluid on Computed Tomography: a Predictor of Surgical Intervention in Patients with Adhesive Small Bowel Obstruction. J Gastrointest Surg 20, 1861–1866 (2016). https://doi.org/10.1007/s11605-016-3244-6

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