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Preoperative findings on non-specific CT in patients with primary acute intestinal ischemia: a case–control study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Primary acute intestinal ischaemia (AII) is an abdominal catastrophe caused by intravascular obstruction of blood supply. It is difficult to diagnose. Computerized tomography (CT) scan is the modality of choice for diagnostic evaluation. Majority of previous studies have evaluated CT findings in patients where AII was suspected. However, unveiling the unique radiological findings also in not initially suspected AII patients, might lead to the timely management of AII patients, and is the aim of this study.

Methods

In a single-center, retrospective case–control study, preoperative radiological findings from abdominal CT scans in 48 patients with primary AII were compared with 80 non-ischemic controls. Radiological findings were analyzed using multivariable logistical regression with adjustment for age and gender and reported as odds ratios (OR) with 95% confidence intervals (CI) and p values.

Results

Thirty-nine (81%) cases with AII were referred to an abdominal CT scan without a specific clinical suspicion of AII. Three main radiological categories (intestinal wall pathology [OR 7.4, CI 2.3–24.0, p value < 0.001], gastrointestinal vessel pathology [OR 19.3, CI 4.6–80.5, p value < 0.001) and intestinal diameter [OR 4.7, CI 1.6–13.4, p value 0.004]) were significantly different in AII patients. Subgroup analysis implied that pneumatosis intestinalis, increased contrast enhancement in the bowel wall, inferior mesenteric artery arteriosclerosis and colonic contraction were predictors of AII.

Conclusion

Radiological changes within the intestinal wall, luminal diameter and gastrointestinal vessels are independent predictors of AII. Awareness of these radiological findings, therefore, plays a central role in patients with an indistinct clinical picture in early recognition and treatment of a life-threatening AII.

Trial registration number

NCT04361110 (April 24, 2020), retrospectively registered.

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Availability of data and material

Due to the nature of this research and the small number of AII patients in the study, identification of the single patients might be possible. This is a violation of the Danish Data protection law, so supporting data is not available.

Code availability

The code that support the findings of this study are available from the corresponding author, DS, upon reasonable request.

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Acknowledgements

The authors are grateful to Søren Lundbye-Christensen (Unit of clinical biostatistics and epidemiology, Aalborg University Hospital, Aalborg, Denmark) for valuable statistical support, and Cara Bhuller for English language assistance.

Funding

Grant support: None.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark

    David Straarup & Ole Thorlacius-Ussing

  2. Department of Surgery, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark

    David Straarup

  3. Department of Gastrointestinal Surgery, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark

    Kåre Andersson Gotschalck

  4. Department of Diagnostic Radiology, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark

    Rasa Mikalone

  5. Department of Clinical Medicine, Aalborg University, Niels Jernes Vej 10, 9220, Aalborg, Denmark

    Ole Thorlacius-Ussing

Authors
  1. David Straarup
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  2. Kåre Andersson Gotschalck
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  3. Rasa Mikalone
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  4. Ole Thorlacius-Ussing
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Correspondence to David Straarup.

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No conflicts of interest exist.

Ethics approval

Ethical approval was given by the The Danish Data Protection Agency under the joint application by The North Denmark Region and by The Scientific Ethical Committee of North Denmark Region (N-20170089).

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Consent to participate in retrospective study is not a demand in Danish law.

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Straarup, D., Gotschalck, K.A., Mikalone, R. et al. Preoperative findings on non-specific CT in patients with primary acute intestinal ischemia: a case–control study. Eur J Trauma Emerg Surg 48, 3025–3032 (2022). https://doi.org/10.1007/s00068-021-01741-w

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  • DOI: https://doi.org/10.1007/s00068-021-01741-w

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