Comparison of computed tomography-enteroclysis and traditional computed tomography in the setting of suspected partial small bowel obstruction
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Traditional computed tomography (CT) is sometimes limited in its ability to diagnose partial small bowel obstruction (SBO), especially if low grade. Standard enteroclysis is sensitive in diagnosing partial SBO; however, extraluminal abnormalities are not well visualized. CT-enteroclysis (CT-E) offers both crosssectional imaging and a contrast volume challenge. CT-E is compared to traditional abdominal/pelvic CT to identify any group(s) of patients who might benefit from having CT-E as the front-line examination.
We performed a retrospective review of 36 patients who underwent both CT-E and traditional CT in the evaluation of suspected partial SBO. Chart review and surgical results were used as gold standards. Sensitivity, specificity, and accuracy were calculated and compared for each modality. Chart review was performed to identify the major referral categories for utilization review.
Two referral categories were identified: (1) patients with a history of malignancy (N=15), and (2) patients with a benign medical or surgical history (N=21). Overall, CT-E was more sensitive (89%; 16 of 18 patients) in diagnosing partial SBO than was traditional CT (50%; 9 of 18). This was especially evident when considering only patients who presented with a history of malignancy. Of these patients, CT-E was 100% sensitive (8 of 8), whereas traditional CT was only 25% sensitive (2 of 8). The specificity of each modality was almost equivalent (100% for CT-E vs. 94% for CT). Of the patients with malignancy, CT-E was able to identify tumor involvement of the small bowel with 100% sensitivity (7 of 7), as compared with only 57% (4 of 7) for traditional CT.
In patients with malignancy, CT-E was found to be superior to traditional CT in identifying partial SBO and in identifying small bowel intraluminal or intramural disease. The greater strength of CT-E is its superiority in excluding disease of the small bowel, a desired trait in the management of patients with malignancy.
Key WordsObstruction small bowel Enteroclysis Computed tomography CT-enteroclysis Malignancy
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