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Prognostic value of MDCT in malignant large-bowel obstructions

Valore prognostico della TCMD nelle occlusioni neoplastiche del grosso intestino

  • Abdominal Radiology/Radiologia Addominale
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to correlate multidetector-row computed tomography (MDCT) findings and postoperative prognosis in malignant large-bowel obstructions.

Materials and methods

Twenty-seven patients affected by malignant colonic obstruction underwent MDCT examination and were analysed for obstruction site, colon-wall morphology, intestinal content alterations and transverse diameter of ascending colon.

Results

Obstruction site was recognised in all cases (5/27 ascending colon; 1/27 transverse colon; 11/27 descending colon; 10/27 sigma-rectum). Intestinal content consisted of mainly air in 3/27 patients, mainly fluid in 11/27 and air-fluid levels in 13/27. In 9/27 cases, pneumatosis intestinalis was found. Mean maximum diameter of the ascending colon was 8.2 cm. Overall mortality rate was 37%. An intestinal content mainly consisting of air (3/3 living patients) or fluid (7/11 living patients) were indicative of good prognosis. Air-fluid level detection indicated poor prognosis in 7/13 cases. Pneumatosis intestinalis (7/9 deceased patients) and ascending colon diameter values ≥10 cm (7/7 deceased patients) were indicative of poor prognosis.

Conclusions

MDCT can identify the presence and site of malignant large-bowel obstructions and may provide useful prognostic information.

Riassunto

Obiettivo

Scopo di questo lavoro è stato ricercare eventuali correlazioni tra informazioni ottenute con tomografia computerizzata multidetettore (TCMD) e prognosi post-operatoria nelle occlusioni neoplastiche del grosso intestino.

Materiali e metodi

Sono state valutate le immagini TCMD di 27 pazienti con occlusione neoplastica del colon e sono stati ricercati: sede dell’ostruzione; morfologia della parete colica; alterazione del contenuto endoluminale; diametro trasversale del colon destro.

Risultati

La sede dell’occlusione è stata riconosciuta in tutti i casi (5/27 colon destro; 1/27 traverso, 11/27 colon sinistro; 10/27 tratto sigma-retto). Il contenuto endoluminale è risultato prevalentemente gassoso in 3/27 pazienti, prevalentemente fluido in 11/27, e di tipo misto, con livelli idroaerei, in 13/27. In 9/27 casi è stata riscontrata pneumatosi parietale. Il diametro massimo del colon destro è risultato in media di 8,2 cm. Il tasso di mortalità complessivo è stato del 37%. Un contenuto colico di tipo gassoso (3/3 pazienti viventi) o prevalentemente liquido (7/11 viventi) ha indicato un’evoluzione prognostica positiva. Il riconoscimento di livelli idroaerei ha indicato prognosi infausta in 7/13 casi. La presenza di pneumatosi parietale (7/9 deceduti) e un diametro del colon destro ≥10 cm (7/7 deceduti) sono risultati indici prognostici sfavorevoli.

Conclusioni

La TCMD consente di riconoscere presenza e sede di un’occlusione neoplastica del grosso intestino e può fornire utili valutazioni prognostiche.

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References/Bibliografia

  1. Landwehr P (2006) Emergency radiology of bowel obstructions. Chirurg 77:889–897

    Article  CAS  PubMed  Google Scholar 

  2. Gatsoulis N, Roukounakis N, Kafetzis I et al (2004) Surgical management of large bowel obstruction due to colonic cancer. Tech Coloproctol 8:S82–S84

    Article  PubMed  Google Scholar 

  3. Aufort S, Charra L, Lesnik A et al (2005) Multidetector CT of bowel obstruction: value of post-processing. Eur Radiol 15:2323–2329

    Article  CAS  PubMed  Google Scholar 

  4. Landis SH, Murray T, Bolden S et al (1998) Cancer statistics, 1998. CA Cancer J Clin 48:6–29

    Article  CAS  PubMed  Google Scholar 

  5. Chapman AH, McNamara M, Porter G (1992) The acute contrast enema in suspected large bowel obstruction: value and technique. Clin Radiol 46:273–278

    Article  CAS  PubMed  Google Scholar 

  6. Markus JB, Somers S, Franic SE et al (1989) Interobserver variation in the interpretation of abdominal radiographs. Radiology 171:69–71

    CAS  PubMed  Google Scholar 

  7. Suri S, Gupta S, Sudhakar PJ et al (1999) Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol 40:422–428

    Article  CAS  PubMed  Google Scholar 

  8. Lim JH, Ko YT, Lee DH et al (1994) Determining the site and causes of colonic obstruction with sonography. AJR Am J Roentgenol 163:1113–1117

    CAS  PubMed  Google Scholar 

  9. Seibert JJ, Williamson SL, Golladay ES et al (1986) The distended gasless abdomen: a fertile field for ultrasound. J Ultrasound Med 5:301–308

    CAS  PubMed  Google Scholar 

  10. Juglard R, Rimbot A, Marty A et al (2003) Bowel obstruction in pregnancy: value of Single Shot Fast Spin Echo MR sequence (SS-FSE). J Radiol 84:1986–1988

    CAS  PubMed  Google Scholar 

  11. McKenna DA, Meehan CP, Alhajeri AN et al (2007) The use of MRI to demonstrate small bowel obstruction during pregnancy. Br J Radiol 80:e11–e14

    Article  CAS  PubMed  Google Scholar 

  12. Maglinte DD, Kelvin FM, Sandrasegaran K et al (2005) Radiology of small bowel obstruction: contemporary approach and controversies. Abdom Imaging 30:160–178

    Article  CAS  PubMed  Google Scholar 

  13. Frager D, Rovno HD, Baer JW et al (1998) Prospective evaluation of colonic obstruction with computed tomography. Abdom Imaging 23:141–146

    Article  CAS  PubMed  Google Scholar 

  14. Caoili EM, Paulson EK (2000) CT of small bowel obstruction: another perspective using multiplanar reformations. AJR Am J Roentgenol 174:993–998

    CAS  PubMed  Google Scholar 

  15. Paulson EK, Jaffe TA, Thomas J et al (2004) MDCT of patients with acute abdominal pain: A new perspective using coronal reformations from submillimeter isotropic voxels. AJR Am J Roentgenol 183:899–906

    PubMed  Google Scholar 

  16. Balthazar EJ, Liebeskind ME, Macari M (1997) Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology 205:519–522

    CAS  PubMed  Google Scholar 

  17. Markogiannakis H, Messaris E, Dardamanis D et al (2007) Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol 13:432–437

    PubMed  Google Scholar 

  18. Sinha R, Verma R (2005) Multidetector row computed tomography in bowel obstruction. Part 2. Large bowel obstruction. Clin Radiol 60:1068–1075

    Article  CAS  PubMed  Google Scholar 

  19. Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–6

    Article  CAS  PubMed  Google Scholar 

  20. De Salvo GL, Gava C, Pucciarelli S et al (2004) Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? Cochrane Database Syst Rev:CD002101. doi:10.1002/14651858.CD002101.pub2

  21. Chen HS, Sheen-Chen SM (2000) Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery 127:370–376

    Article  CAS  PubMed  Google Scholar 

  22. Lee YM, Law WL, Chu KW et al (2001) Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 192:719–725. doi:10.1016/S1072-7515(01)00833-X

    Article  CAS  PubMed  Google Scholar 

  23. Mulcahy HE, Skelly MM, Husain A et al (1996) Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 83:46–50

    Article  CAS  PubMed  Google Scholar 

  24. Huang TJ, Wang JY, Lee LW et al (2002) Emergency one-stage surgery for obstructing left-sided colorectal carcinomas. Kaohsiung J Med Sci 18:323–328

    PubMed  Google Scholar 

  25. Celban G, JabΠonka, Solnica C (2005) Acute malignant large bowel obstruction-early outcomes and prognostic risk factors. Wiad Lek 58:161–165

    PubMed  Google Scholar 

  26. Caspary WF (1992) Physiology and pathophysiology of intestinal absorption. Am J Clin Nutr 55:299S–308S

    CAS  PubMed  Google Scholar 

  27. Van Leeuwen PA, Boermeester MA, Houdijk AP et al (1994) Clinical significance of translocation. Gut 35:S28–S34

    Article  PubMed  Google Scholar 

  28. Meyers MA (1977) Colonic ileus. Gastrointest Radiol 2:37–40

    Article  CAS  PubMed  Google Scholar 

  29. Lowman RM, Davis L (1956) An evaluation of cecal size in impending perforation of the cecum. Surg Gynecol Obstet 103:711–718

    PubMed  Google Scholar 

  30. Kottler RE, Lee GK (1984) The threatened caecum in acute large-bowel obstruction. Br J Radiol 57:989–990

    Article  CAS  PubMed  Google Scholar 

  31. Chmidt AG (1968) Intramural gas proximal to obstructing carcinoma. Radiology 91:784–785

    CAS  PubMed  Google Scholar 

  32. Ho LM, Paulson EK, Thompson WM (2007) Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol 188:1604–1613

    Article  PubMed  Google Scholar 

  33. Greenstein AJ, Nguyen SQ, Berlin A et al (2007) Pneumatosis intestinalis in adults: management, surgical indications, and risk factors for mortality. J Gastrointest Surg 11:1268–1274

    Article  PubMed  Google Scholar 

  34. Stein JM, Schneider AR (2007) Bacterial overgrowth syndrome. Z Gastroenterol 45:620–628

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Di.M.I.M.P. - Sezione di Diagnostica per Immagini, Policlinico Universitario, Piazza Giulio Cesare 11, 70124, Bari, Italy

    G. Angelelli, M. Moschetta, F. Binetti, T. Cosmo & A.A. Stabile Ianora

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  1. G. Angelelli
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  2. M. Moschetta
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  3. F. Binetti
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  4. T. Cosmo
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  5. A.A. Stabile Ianora
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Correspondence to G. Angelelli.

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Angelelli, G., Moschetta, M., Binetti, F. et al. Prognostic value of MDCT in malignant large-bowel obstructions. Radiol med 115, 747–757 (2010). https://doi.org/10.1007/s11547-010-0527-y

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  • DOI: https://doi.org/10.1007/s11547-010-0527-y

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