Gastrointestinal Radiology

, Volume 12, Issue 1, pp 245–249 | Cite as

Analysis of the tethered-bowel sign on abdominal CT as a predictor of malignant ascites

  • Steven E. Seltzer


The value of the “tethered-bowel sign” as a predictor of the nature of intraabdominal fluid was assessed. In the presence of moderate amounts of abdominal fluid, the sign was said to be positive if small or large bowel loops were not seen to float freely on computed tomographic (CT) images, and did not make contact with the anterior abdominal wall. A positive sign was significantly associated with the presence of malignant cells in the fluid (P<0.005). When equivocal cases were excluded, the sign had a sensitivity of 85%, a specificity of 93%, and an accuracy of 88%. In the study population (64% prevalence of malignant fluid), the sign had a positive predictive value of 96%, but a negative predictive value of only 78%. When equivocal cases were included, the sensitivity dropped to 69%, the specificity to 78%, and the accuracy to 72%. It is concluded that CT evidence of tethered-bowel loops strongly suggests a malignant cause of ascitic fluid.

Key words

Ascites CT investigation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Yeh H-C, Wolf BS: Ultrasonography in ascites.Radiology 124:783–790, 1977Google Scholar
  2. 2.
    Bundrick T, Cho S-R, Ammann A, Walsh JW: Intraperitoneal carcinomatosis: incidence of its radiographic findings and description of a new sign.Br J Radiol 56:13–16, 1983Google Scholar
  3. 3.
    Gordon L, Schabel SI, Holland RD, Cooper JF:99mTc-methylene diphosphonate accumulation in ascitic fluid due to neoplasm.Radiology 139:699–702, 1981Google Scholar
  4. 4.
    Gefter WB, Arger PH, Edell SL: Sonographic patterns of ascites.Semin Ultrasound 2:226–232, 1981Google Scholar
  5. 5.
    Tsujimoto F, Miyamoto Y, Tada S: Differentiation of benign from malignant ascites by sonographic evaluation of gallbladder wall.Radiology 157:503–504, 1985Google Scholar
  6. 6.
    Cohen JM, Weinreb JC, Maravilla KR: Fluid collections in the intraperitoneal and extraperitoneal spaces: comparison of MR and CT.Radiology 155:705–708, 1985Google Scholar
  7. 7.
    Jolies H, Coulam CM: CT of ascites: differential diagnosis.AJR 135:315–322, 1980Google Scholar
  8. 8.
    Gore RM, Callen PW, Filly RA: Lesser sac fluid in predicting the etiology of ascites: CT findings.AJR 139:71–74, 1982Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1987

Authors and Affiliations

  • Steven E. Seltzer
    • 1
  1. 1.Department of RadiologyHarvard Medical School, Brigham and Women's HospitalBostonUSA

Personalised recommendations