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Value of CT findings to predict surgical ischemia in small bowel obstruction: A systematic review and meta-analysis

  • Emergency Radiology
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Abstract

Purpose

Our aim was to assess the diagnostic performance in determining strangulation in small bowel obstruction (SBO) for five CT findings commonly considered in published small bowel obstruction (SBO) management guidelines.

Materials and methods

Medical databases were searched for “bowel obstruction”, “computed tomography”, “strangulation”, and related terms. Two reviewers independently selected articles for CT findings investigated with surgical or histological reference standards for strangulation. Bivariate random-effects meta-analytical methods were used.

Results

A total of 768 patients, including 205 with strangulation from nine studies, were evaluated. The reduced bowel wall enhancement CT sign had the highest specificity (95 %, CI 75–99), with a positive LR of 11.07 (2.27–53.88) and DOR of 22.86 (4.99–104.61). The mesenteric fluid sign had the highest sensitivity (89 %, CI 75–96) with a negative LR of 0.16 (0.07–0.39) and a DOR of 13.9 (5.73–33.75). The bowel wall thickness had a sensitivity of 48 % (CI 41–54), a specificity of 83 % (CI 74–89), a positive LR of 2.84 (1.83–4.41) and a negative LR of 0.62 (0.53–0.72). The other CT findings had lower diagnostic performance.

Conclusion

Two CT findings should be used in clinical practice: reduced enhanced bowel wall is highly predictive of ischemia, and absence of mesenteric fluid is a reliable finding to rule out strangulation.

Key Points

Reduced bowel wall enhancement on CT increases the probability of strangulation 11-fold.

Absence of mesenteric fluid on CT decreases the probability of strangulation 6-fold.

The clinical reliability of other CT signs is doubtful for predicting strangulation.

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Acknowledgements

The scientific guarantor of this publication is Patrice Taourel. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because it was a meta-analytic study with evaluation of retrospective published studies. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, multicenter study.

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Correspondence to Ingrid Millet.

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Appendices

Appendix E1 Forest plot of sensitivity and specificity according to each CT finding. Numbers in brackets are 95 % CIs

A. Decreased enhanced wall

figure a

B. Wall thickness

figure b

C. Mesenteric congestion

figure c

D. Mesenteric fluid

figure d

E. Peritoneal fluid

figure e

Appendix Z Funnel plot for publication bias for each CT finding

A. Decreased enhanced wall

figure f

B. B- Wall thickness

figure g

C. Mesenteric congestion

figure h

D. Mesenteric fluid

figure i

E. Peritoneal fluid

figure j

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Millet, I., Taourel, P., Ruyer, A. et al. Value of CT findings to predict surgical ischemia in small bowel obstruction: A systematic review and meta-analysis. Eur Radiol 25, 1823–1835 (2015). https://doi.org/10.1007/s00330-014-3440-2

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  • DOI: https://doi.org/10.1007/s00330-014-3440-2

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