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MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

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Abstract

Small bowel obstruction (SBO) accounts for a considerable proportion of emergency room visits, inpatient admissions, and surgical interventions in the United States. Multi-detector computed tomography (MDCT) plays a key role in imaging patients presenting with acute symptoms suggestive of SBO, which helps in establishing the diagnosis, elucidating the cause of obstruction, and detecting complications, such as ischemia or frank bowel necrosis and perforation. Recently, management of patients with SBO has shifted toward a more conservative approach with supportive care and nasogastric tube decompression, as the obstruction in many cases can resolve spontaneously without the need for operative intervention. However, management decisions in SBO remain notoriously difficult, relying on a combination of clinical, laboratory, and imaging factors to help stratify patients into conservative or surgical treatment. Imaging is often an important factor assisting in the decision-making process since traditional clinical signs of vascular compromise, such as acidosis, fever, leukocytosis, and tachycardia are often unreliable in predicting the need for operative intervention. Thus, it is critically important for radiologists to identify imaging features that suggest or indicated high likelihood of bowel vascular compromise in order to help optimize management prior to the development of bowel ischemia and eventually necrosis. By excluding signs of potentially ischemic or necrotic bowel on MDCT, patients may be spared unnecessary surgery, thus decreasing postsurgical complications and averting potential increase for the risk of future SBO and repeated surgery. Conversely, if imaging features indicate potential vascular compromise of the bowel wall that may lead to bowel ischemia, urgent surgical intervention may prevent progression to bowel necrosis and subsequent perforation.

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Authors and Affiliations

  1. Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, Ann Arbor, MI, 48109, USA

    Mahmoud M. Al-Hawary, Ravi K. Kaza, Ashish P. Wasnik, Joel F. Platt & Isaac R. Francis

  2. Department of Radiology, UW Medical Center Radiology/Imaging Services, 1959 NE Pacific Street, SS-202, Seattle, WA, 98195-7117, USA

    Ryan G. O’Malley

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  1. Ryan G. O’Malley
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  2. Mahmoud M. Al-Hawary
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Correspondence to Mahmoud M. Al-Hawary.

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O’Malley, R.G., Al-Hawary, M.M., Kaza, R.K. et al. MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions. Abdom Imaging 40, 2248–2262 (2015). https://doi.org/10.1007/s00261-015-0477-x

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