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COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF SUSPECTED LARGE BOWEL OBSTRUCTION
Author(s) -
Beattie Garth C.,
Peters Robert T.,
Guy Susanne,
Mendelson Richard M.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2006.03998.x
Subject(s) - medicine , supine position , radiology , bowel obstruction , computed tomography , positive predicative value , radiography , enema , predictive value , surgery
Background: The aim of this study was to assess the efficacy of computed tomography (CT) scanning in the diagnosis of acute large bowel obstruction. Methods: Forty‐four patients (22 men; 22 women, ages 39–94 years, mean 71 years) with clinical features and abdominal radiographic findings suggesting acute large bowel obstruction (LBO) or pseudo‐obstruction were examined with CT. Supine scans were obtained with i.v. contrast medium (unless contraindicated), but (in the majority) without oral contrast. Additional prone and/or decubitus scans were obtained in 33 patients when clarification of a possible transition point on the supine scan was required. CT diagnosis of LBO was made by finding a transition point ± mass. Final diagnosis was confirmed by surgery, further imaging and/or clinical course. Results: Twenty‐two patients had proven mechanical acute LBO of whom 18 had an obstructing carcinoma; 22 patients had no mechanical obstruction. Sensitivity, specificity, Positive Predictive Value, Negative Predictive Value of CT for diagnosis of mechanical LBO were each 91%. Positive and negative likelihood ratios were 10.1 and 0.1, respectively. There were two false‐negative CT scans, although one of these was reported as showing segmental mural thickening. A mass was identified on 14 of 17 patients with true‐positive CT, subsequently found to have carcinoma. Conclusion: Computed tomography with additional selective prone and/or decubitus scanning is highly effective in the diagnosis of mechanical LBO. It is suggested that it replace contrast enema as the initial imaging method.