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Helical CT in the Diagnosis of Small Bowel Obstruction¹

¹ From the Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho Otsu, Shiga 520-2192, Japan (A.F., M.Y., K.F., M.T., K.M.); the Department of Radiology, Shin Kori Hospital, Hirakata, Japan (K.Y.); the Department of Radiology, Ijinkai Takeda Hospital, Kyoto, Japan (T.N.); and the Department of Radiology, Koga Public Hospital, Koga, Japan (T.S.). Recipient of a Certificate of Merit for a scientific exhibit at the 1999 RSNA scientific assembly. Received May 2, 2000; revision requested June 5 and received August 1; accepted August 3. Address correspondence to A.F. (e-mail: akira@belle.shiga-med.ac.jp).

With recent technologic developments, the role of computed tomography (CT) in the diagnosis of bowel obstruction has expanded. CT is recommended when clinical and initial radiographic findings remain indeterminate or strangulation is suspected. This modality clearly demonstrates pathologic processes involving the bowel wall as well as the mesentery, mesenteric vessels, and peritoneal cavity. CT should be performed with intravenous injection of contrast material, and use of thin sections is recommended to evaluate a particular region of interest. CT is reported to have a sensitivity of 78%–100% for the detection of complete or high-grade small bowel obstruction but may not allow accurate diagnosis in cases involving incomplete obstruction. In such cases, the use of adjunct enteroclysis is indicated. Furthermore, multiplanar reformatted imaging may help identify the site, level, and cause of obstruction when axial CT findings are indeterminate. CT can also demonstrate findings that indicate the presence of closed-loop obstruction or strangulation, both of which necessitate emergency exploratory laparotomy. Unfortunately, these pathologic conditions may be missed, and patients with suspected severe obstruction or bowel ischemia in whom CT and clinical findings are widely disparate must also undergo laparotomy. In general, however, CT allows appropriate and timely management of these emergency cases.

Index Terms: Intestines, CT, 74.1211 • Intestines, hernia, 74.157, 74.158 • Intestines, stenosis or obstruction, 74.723, 74.724 • Intussusception, 74.732

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