Increased unenhanced bowel-wall attenuation: a specific sign of bowel necrosis in closed-loop small-bowel obstruction
Résumé
OBJECTIVES: To identify computed tomography (CT) findings associated with bowel necrosis in patients with surgically confirmed strangulating closed-loop small-bowel obstruction (CL-SBO) due to adhesions or internal hernia. METHODS: This retrospective study was approved by our institutional review board, and informed consent was waived. To identify CT signs of bowel necrosis, two gastrointestinal radiologists performed blinded, independent, retrospective reviews of 41 CT studies from consecutive patients who had CL-SBO due to adhesions or internal hernias and who underwent surgery within 48 h. On the basis of surgical and pathological findings, patients were classified as having reversible ischemia or histologically documented necrosis. Univariate statistical analyses were performed to assess associations between CT signs and bowel necrosis. Kappa statistics were computed to assess interobserver agreement. RESULTS: We included 25 (61%) women and 16 (39%) men with a median age of 79 years. Bowel necrosis was found in 25/41 (61%) patients and ischemic but viable bowel in 16/41 (39%) patients. Increased unenhanced bowel-wall attenuation was the only CT finding significantly associated with bowel necrosis (p = 0.0002). This sign had 58% (95% CI, 37-78) sensitivity and 100% (95% CI, 79-100) specificity for necrosis. Interobserver agreement was fair (0.59; 95% CI, 0.37-0.82). CONCLUSION: Increased unenhanced bowel-wall attenuation is specific for bowel necrosis and should lead to prompt surgery for bowel resection. KEY POINTS: \textbullet Increased unenhanced bowel-wall attenuation is the only sign specific for necrosis \textbullet Decreased bowel-wall enhancement is not relevant for differentiating reversible ischemia from necrosis \textbullet Preoperative knowledge of bowel necrosis is helpful to plan adequate surgery.
Mots clés
Humans
Female
Male
Retrospective Studies
Sensitivity and Specificity
Adult
Aged
Middle Aged
80 and over
Young Adult
Tomography
X-Ray Computed
Research Design
Imaging
Contrast Media
Radiologists
Ischemia
Necrosis
Biometry
Helical computed tomography
Intestinal obstruction
Intestine
Small
Small intestine
Vascular Diseases