Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis.

Abstract

PURPOSE: To determine the accuracy of computed tomography (CT) in diagnosis of intestinal ischemia in patients with possible intestinal obstruction and the limitations and clinical implications of use of CT. MATERIALS AND METHODS: In 100 patients in whom intestinal obstruction was suspected clinically, CT findings were correlated with surgical findings in 77 patients and with follow-up clinical findings after nasogastric suction in 23 patients. The interval between CT and surgical exploration in patients with ischemic bowel was 1-98 hours (mean, 13 hours). RESULTS: Correlation of CT findings of strangulation obstruction with surgical findings revealed 72 true-negative, 19 true-positive, five false-positive, and four false-negative CT results. Sensitivity was 83%, specificity was 93%, accuracy was 91%, positive predictive value was 79%, and negative predictive value was 95%. CONCLUSION: CT enables accurate detection of bowel ischemia, particularly when small bowel obstruction is present. Exploratory laparotomy should be performed when unexplained disparities exist between equivocal CT findings and a deteriorating clinical condition in patients with possible small bowel obstruction or mesenteric infarction.