European Radiology

, Volume 25, Issue 4, pp 922–931 | Cite as

Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

  • Ya-Cheng Chen
  • Chang-Hsien Liu
  • Hsian-He Hsu
  • Chih-Yung Yu
  • Hong-Hau Wang
  • Hsiu-Lung Fan
  • Ran-Chou Chen
  • Wei-Chou Chang



The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO).


We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air–fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared.


A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, −59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < −11.75 HU predicted phytobezoar impaction.


MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces.

Key Points

MDCT examination helps to differentiate phytobezoar and small-bowel faeces.

A higher grade of obstruction is commonly associated with phytobezoar impaction.

Mesenteric fatty stranding and intraperitoneal fluid are frequently associated with small-bowel faeces.

Quantitative measurement of the obstructed bowel adds the diagnostic accuracy.


Phytobezoar Small-bowel obstruction Small-bowel faeces Adhesion Multi-detector computed tomography 



Small-bowel obstruction


Multi-detector computed tomography



We would like to give special thanks to Benjamin Yen, M.D., professor at the University of California, San Francisco, for his guidance and help. We thank the Research Office for Health Data, Department of Education and Research, Taipei City Hospital, Taiwan for their valuable contributions in data management and statistical analysis.

The scientific guarantor of this publication is Wei-Chou, Chang. This study has received funding by Tri-Service General Hospital Research Grant (TSGH-C100-044). The Research Office for Health Data, Department of Education and Research, Taipei City Hospital, Taiwan kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. (TSGHIRB-1-101-05-091). Written informed consent was not required for this study because our study is a retrospective study for imaging differentiation, and does no harm to human bodies. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, was performed at one institution.


  1. 1.
    Mullen CP, Siewert B, Eisenberg RL (2012) Small bowel obstruction. AJR Am J Roentgenol 198:W105–W117CrossRefGoogle Scholar
  2. 2.
    Furukawa A, Yamasaki M, Furuichi K, Yokoyama K, Nagata T et al (2001) Helical CT in the diagnosis of small bowel obstruction. Radiographics 21:341–355CrossRefPubMedGoogle Scholar
  3. 3.
    Delabrousse E, Lubrano J, Jehl J et al (2009) Small-bowel obstruction from adhesive bands and matted adhesions: CT differentiation. AJR Am J Roentgenol 192:693–697CrossRefPubMedGoogle Scholar
  4. 4.
    Mayo-Smith WW, Wittenberg J, Bennett GL, Gervais DA, Gazelle GS, Mueller PR (1995) The CT small bowel faeces sign: description and clinical relevance. Clin Radiol 50:765–767CrossRefPubMedGoogle Scholar
  5. 5.
    Delabrousse E, Lubrano J, Sailley N, Aubry S, Mantion GA, Kastler BA (2008) Small-bowel bezoar versus small-bowel feces: CT evaluation. AJR Am J Roentgenol 191:1465–1468CrossRefPubMedGoogle Scholar
  6. 6.
    Ripolles T, Garcia-Aguayo J, Martinez MJ, Gil P (2001) Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol 77:65–69CrossRefGoogle Scholar
  7. 7.
    Zissin R, Osadchy A, Gutman V, Rathaus V, Shapiro-Feinberg M, Gayer G (2004) CT findings in patients with small bowel obstruction due to phytobezoar. Emerg Radiol 10:197–200CrossRefPubMedGoogle Scholar
  8. 8.
    Yildirim T, Yildirim S, Barutcu O, Oguzkurt L, Noyan T (2002) Small bowel obstruction due to phytobezoar: CT diagnosis. Eur Radiol 12:2659–2661PubMedGoogle Scholar
  9. 9.
    Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M (2004) Frequency and relevance of the “small-bowel feces” sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol 183:1361–1366CrossRefPubMedGoogle Scholar
  10. 10.
    Kim JH, Ha HK, Sohn MJ et al (2003) CT findings of phytobezoar associated with small bowel obstruction. Eur Radiol 13:299–304CrossRefPubMedGoogle Scholar
  11. 11.
    Silva AC, Pimenta M, Guimarães LS (2009) Small bowel obstruction: what to look for. Radiographics 29:423–439CrossRefPubMedGoogle Scholar
  12. 12.
    Ko SF, Lee TY, Ng SH (1997) Small bowel obstruction due to phytobezoar: CT diagnosis. Abdom Imaging 22:471–473CrossRefPubMedGoogle Scholar
  13. 13.
    Gayer G, Jonas T, Apter S et al (1999) Bezoars in the stomach and small bowel—CT appearance. Clin Radiol 54:228–232CrossRefPubMedGoogle Scholar
  14. 14.
    Ho TW, Koh DC (2007) Small-bowel obstruction secondary to bezoar impaction: a diagnostic dilemma. World J Surg 31:1072–1078CrossRefPubMedGoogle Scholar
  15. 15.
    Oh SH, Namgung H, Park MH, Park DG (2012) Bezoar-induced small bowel obstruction. J Korean Soc Coloproctol 28:89–93CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Quiroga S, Alvarez-Castells A, Sebastia MC, Pallisa E, Barluenga E (1997) Small bowel obstruction secondary to bezoar: CT diagnosis. Abdom Imaging 22:315–317CrossRefPubMedGoogle Scholar
  17. 17.
    Jacobs SL, Rozenblit A, Ricci Z et al (2007) Small bowel faeces sign in patients without small bowel obstruction. Clin Radiol 62:353–357CrossRefPubMedGoogle Scholar
  18. 18.
    Chang WC, Ko KH, Lin CS et al (2014) Features on MDCT that predict surgery in patients with adhesive-related small bowel obstruction. PLoS ONE 9:e89804CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Ya-Cheng Chen
    • 1
  • Chang-Hsien Liu
    • 1
  • Hsian-He Hsu
    • 1
  • Chih-Yung Yu
    • 1
  • Hong-Hau Wang
    • 1
    • 2
  • Hsiu-Lung Fan
    • 3
  • Ran-Chou Chen
    • 4
    • 5
  • Wei-Chou Chang
    • 1
    • 5
  1. 1.Department of RadiologyTri-Service General Hospital, National Defense Medical CenterTaipeiTaiwan, Republic of China
  2. 2.Department of RadiologyTri-Service General Hospital Songshan Branch, National Defense Medical CenterTaipeiTaiwan, Republic of China
  3. 3.Division of General Surgery, Department of SurgeryTri-Service General Hospital, National Defense Medical CenterTaipeiTaiwan, Republic of China
  4. 4.Department of RadiologyTaipei City HospitalTaipeiTaiwan, Republic of China
  5. 5.Department of Biochemical Imaging and Radiological SciencesNational Yang-Ming UniveristyTaipeiTaiwan, Republic of China

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