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Usefulness of Known Computed Tomography and Clinical Criteria for Diagnosing Strangulation in Small-Bowel Obstruction: Analysis of True and False Interpretation Groups in Computed Tomography

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Abstract

Computed tomography (CT) criteria have proven useful, but not sufficient, for diagnosis of bowel strangulation. The purpose of the present study was to evaluate the useof clinical criteria in the interpretation of CT scans as a means of improving the diagnostic accuracy of CT, especially in patients whose CT scans are equivocal for distinguishing simple obstruction from strangulated obstruction. We analyzed the CT scans of 136 patients with simple (n = 70) or strangulated (n = 66) small-bowel obstruction. Three radiologists interpreted the CT scans independently for the presence of intestinal strangulation. According to their interpretation, 136 patients were divided into two groups, i.e., a false and a true interpretation group. The diagnostic value of known CT and four clinical criteria (tenderness, tachycardia, fever, and leukocytosis) were compared in the two groups. The diagnostic accuracy of CT criteria for distinguishing simple obstructions from strangulated small-bowel obstructions ranged between 73% and 80%. Of the 136 patients, 31 belonged to the false group and 105 to the true group. The CT criteria that were highly specific in both groups included severe mesenteric haziness, serrated beak, and poor bowel wall enhancement. Among the clinical criteria, both tachycardia and leukocytosis were highly specific in both groups. The number of positive clinical criteria was helpful in making a diagnosis; none or one clinical criterion indicated a simple obstruction, whereas three or four criteria indicated a strangulated obstruction; when this result was applied retrospectively to the false group, the CT diagnostic accuracy improved in 19 of the 31 patients. The use of clinical criteria when CT findings are equivocal, may overcome the inherent limitations of CT for diagnosing strangulated small-bowel obstruction.

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Acknowledgments.

We thank Bonnie Hami, University Hospitals of Cleveland, for her editorial assistance in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Ku, 138-040, Seoul, Korea

    Jung Hoon Kim M.D., Hyun Kwon Ha M.D., Jeong Kon Kim M.D., Hyo Won Eun M.D., Kwang Bo Park M.D., Bong Soo Kim M.D. & Tae Kyoung Kim M.D.

  2. Department of General Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Ku, 138-040, Seoul, Korea

    Jin Chen Kim M.D.

  3. Department of Radiology, New Jersey Medical School, University Hospital, 150 Bergen Street, 07103, Newark, New Jersey, USA

    Yong Ho Auh M.D.

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  1. Jung Hoon Kim M.D.
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Correspondence to Hyun Kwon Ha M.D..

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Kim, J., Ha, H., Kim, J. et al. Usefulness of Known Computed Tomography and Clinical Criteria for Diagnosing Strangulation in Small-Bowel Obstruction: Analysis of True and False Interpretation Groups in Computed Tomography. World J. Surg. 28, 63–68 (2004). https://doi.org/10.1007/s00268-003-6899-6

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