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Wang S, Zhang D, Lu H, Liu H, Shan Y, Li S. Conversion to open surgery in laparoscopic approach of adhesive small bowel obstruction: Predictive factors and its impact on short-term outcomes. Am J Surg 2025; 244:116291. [PMID: 40120543 DOI: 10.1016/j.amjsurg.2025.116291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 02/17/2025] [Accepted: 03/06/2025] [Indexed: 03/25/2025]
Abstract
BACKGROUND Small bowel obstruction is a common surgical emergency. Laparoscopy has been increasingly used for the treatment of adhesive small bowel obstruction (ASBO), but its indications remain unclear. In this study, we aimed to identify the risk factors for conversion to open surgery after laparoscopic ASBO treatment and evaluate the impact of conversion on short-term outcomes. METHODS All patients diagnosed with ASBO who initially underwent laparoscopic approach after the failure of conservative treatment between December 2020 and May 2024 were reviewed. Patients were categorized into two groups based on the surgical approach: the totally laparoscopic group (group 1) and the conversion to open surgery group (group 2). The demographic, clinical, and radiological features were compared, and risk factors were identified via univariate and multivariate analyses. The intraoperative findings and postoperative outcomes were evaluated. RESULTS A total of 102 patients (43 in group 1 and 59 in group 2) were included. The time between home and admission (P = 0.014) and the abdominal wall ratio (P < 0.001) were significantly higher in group 2 than in group 1, whereas the number of prior abdominal surgeries (P = 0.010) and the rate of beak signs were significantly lower in group 2 than in group 1. The operative time (P < 0.001), blood lost (P < 0.001), medical expenses (P < 0.001), total hospital length of stay (P < 0.001), and postoperative hospital length of stay (P < 0.001) were significantly higher in group 2 than in group 1. Multivariate analysis revealed that a large abdominal wall ratio (odds ratio [OR]: 4538.7; 95 % confidence interval [CI]: 8.5-2426334.8; P = 0.009) was a risk factor for conversion, whereas the presence of beak signs (OR: 0.186; 95 % CI: 0.05-0.64, P = 0.008) was a significant protective factor. CONCLUSIONS A large abdominal wall ratio is an independent risk factor for conversion, whereas the presence of beak signs is a protective factor. The conversion from laparoscopic surgery to open surgery is safe with proper management of conversion indications.
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Affiliation(s)
- Shengqiang Wang
- Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Dawei Zhang
- Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Hao Lu
- Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Hairui Liu
- Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Yuping Shan
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Shikuan Li
- Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Mulé S, Brault B, Blain M, Neifar N, Touloupas C, Boulay-Coletta I, Reizine E, Luciani A, Zins M. Value of dual-energy computed tomography in the diagnosis of bowel ischemia in patients with mechanical small-bowel obstruction: a retrospective, dual-center study. Eur Radiol 2025:10.1007/s00330-025-11635-9. [PMID: 40328956 DOI: 10.1007/s00330-025-11635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 03/12/2025] [Accepted: 03/23/2025] [Indexed: 05/08/2025]
Abstract
OBJECTIVES To investigate the diagnostic value of rapid-kV-switching dual-energy CT (DECT) for identifying bowel ischemia in patients with mechanical small-bowel obstruction (SBO), compared to 120 kVp-equivalent CT. MATERIALS AND METHODS This retrospective dual-center study included 112 patients with mechanical SBO. Clinical and surgical outcomes with histological findings were recorded as the reference standard. Three readers independently reviewed true unenhanced (TUE) and portal-venous 77-keV virtual monoenergetic images (VMI) (dataset#1), virtual unenhanced (VUE), iodine, and 50-keV VMI (dataset#2). Ischemia was defined as the presence of at least two CT features among reduced bowel-wall enhancement, diffuse mesenteric haziness, and a closed-loop mechanism. Unenhanced bowel-wall attenuation was also analysed. Bowel-wall attenuation and iodine concentration were measured in involved loops and proximal dilated loops. Sensitivity and specificity were calculated for each CT feature. Association between iodine concentration and bowel ischemia was analysed using ROC curves. RESULTS Forty-one (37%) patients underwent surgery. Twenty-four (21%) patients had findings of bowel ischemia, including 11 (10%) patients with irreversible ischemia (necrosis). Diagnostic performance for ischemia and necrosis was similar between both datasets for all readers (p > 0.49 for ischemia and p = 1 for necrosis). Increased bowel-wall attenuation on VUE or TUE images had a non-significantly different diagnostic value for all readers (p > 0.21 for ischemia and p > 0.78 for necrosis). Bowel-wall iodine concentration identified bowel necrosis with 82% sensitivity and 83% specificity (optimal cutoff value 1.82 mg/mL). CONCLUSION DECT performed similarly to 120 kVp-equivalent CT for the diagnosis of bowel ischemia in patients with mechanical SBO. VUE images offer a viable alternative to TUE images for the identification of increased bowel-wall attenuation. Bowel-wall iodine concentration accurately identifies bowel necrosis. KEY POINTS Question Dual-energy CT (DECT) could detect small-bowel ischemia caused by mechanical small-bowel obstruction (SBO), but its performance is unknown. Findings Reduced bowel-wall enhancement and increased unenhanced bowel-wall attenuation were not significantly different between DECT and 120 kVp-equivalent CT. Bowel-wall iodine concentration identified necrosis with 82% sensitivity and 83% specificity. Clinical relevance DECT performed similarly to 120 kVp-equivalent CT in depicting bowel ischemia in patients with mechanical SBO, while adding quantitative analysis of bowel-wall iodine concentration may further help identify patients requiring surgery.
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Affiliation(s)
- Sébastien Mulé
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000, Créteil, France.
- Faculty of Health, University of Paris Est Créteil, Créteil, France.
- INSERM IMRB, U 955, Team 18, Créteil, France.
| | - Baptiste Brault
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Maxime Blain
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000, Créteil, France
- Faculty of Health, University of Paris Est Créteil, Créteil, France
| | - Nada Neifar
- Department of Medical Imaging, Paris Saint Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - Caroline Touloupas
- Department of Medical Imaging, Paris Saint Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - Isabelle Boulay-Coletta
- Department of Medical Imaging, Paris Saint Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
| | - Edouard Reizine
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000, Créteil, France
- Faculty of Health, University of Paris Est Créteil, Créteil, France
- INSERM IMRB, U 955, Team 18, Créteil, France
| | - Alain Luciani
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000, Créteil, France
- Faculty of Health, University of Paris Est Créteil, Créteil, France
- INSERM IMRB, U 955, Team 18, Créteil, France
| | - Marc Zins
- Department of Medical Imaging, Paris Saint Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
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Yamada T, Aoki Y, Matsuda A, Yokoyama Y, Takahashi G, Iwai T, Shinji S, Sonoda H, Uehara K, Yoshida H. Diagnosis of necrotic and non-necrotic small bowel strangulation: The importance of intestinal congestion. Ann Gastroenterol Surg 2025; 9:538-545. [PMID: 40385344 PMCID: PMC12080211 DOI: 10.1002/ags3.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 11/14/2024] [Accepted: 11/21/2024] [Indexed: 05/20/2025] Open
Abstract
Background Despite the prevalence of laparoscopic techniques in abdominal surgeries today, bowel obstruction remains a potentially serious complication. Small bowel strangulation (SBS), in particular, is a critical condition that can lead to patient mortality. However, the prognosis for SBS is favorable if surgery is performed before the onset of necrosis. Non-necrotic SBS is a reversible condition in which blood flow can be restored by relieving the strangulation. The purpose of this study was to identify sensitive and specific contrast-enhanced computed tomography (CT) findings that are useful for diagnosis of both non-necrotic and necrotic SBS. Methods We included patients diagnosed with SBS and simple bowel obstruction (SBO) who underwent contrast-enhanced CT followed by surgery from 2006 to 2023. Two gastrointestinal surgeons independently assessed the images retrospectively. Results Eighty SBO and 141 SBS patients were included. Eighty-seven had non-necrotic SBS and 54 had necrotic SBS. Mesenteric edema was most frequently observed in both necrotic and non-necrotic SBS cases followed by abnormal bowel wall thickening. These two findings were observed significantly less frequently in SBO. Bowel hypo-enhancement is identified in only about half of the non-necrotic SBS cases, and it was detected at significantly higher rates in necrotic SBS compared to non-necrotic. Conclusion Mesenteric edema and abnormal bowel wall thickening are sensitive and specific signs of both non-necrotic and necrotic SBS. These two findings indicate mesenteric and bowel congestion. Detecting intestinal congestion can lead to an accurate diagnosis of SBS, particularly in case of non-necrotic SBS, where bowel hypo-enhancement may sometimes be absent.
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Affiliation(s)
- Takeshi Yamada
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Yuto Aoki
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Akihisa Matsuda
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Yasuyuki Yokoyama
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Goro Takahashi
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Takuma Iwai
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Seiichi Shinji
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Hiromichi Sonoda
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Kay Uehara
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
| | - Hiroshi Yoshida
- Department of Gastroenterological SurgeryNippon Medical SchoolTokyoJapan
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Zins M, Frandon J, Millet I. Assessment of ischemia in mechanical small bowel obstruction: The time has come for dual-energy CT. Diagn Interv Imaging 2025; 106:113-114. [PMID: 39848829 DOI: 10.1016/j.diii.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Accepted: 01/08/2025] [Indexed: 01/25/2025]
Affiliation(s)
- Marc Zins
- Department of Medical Imaging, Hôpitaux Paris Saint Joseph & Marie Lannelongue, 75014 Paris, France.
| | - Julien Frandon
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, 30900 Nîmes, France
| | - Ingrid Millet
- Department of Medical Imaging, Lapeyronie University Hospital, 34295 Montpellier, France; Desbrest Institute of Epidemiology and Public Health (IDESP), Montpellier University, INSERM, 34000 Montpellier, France
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Lamant F, Simon G, Busse-Coté A, Hassoun Y, Roussel B, Verdot P, Doussot A, Lakkis Z, Delabrousse E, Calame P. Assessment of small bowel ischemia in mechanical small bowel obstruction: Diagnostic value of bowel wall iodine concentration using dual-energy CT. Diagn Interv Imaging 2025; 106:126-134. [PMID: 39550287 DOI: 10.1016/j.diii.2024.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 10/19/2024] [Accepted: 10/30/2024] [Indexed: 11/18/2024]
Abstract
PURPOSE The purpose of this study was to determine whether dual-energy computed tomography (DECT), specifically by measuring bowel wall iodine concentration (BWIC), is superior to monoenergetic reconstructions (MR) for the diagnosis and staging of small bowel ischemia in patients with mechanical small bowel obstruction (SBO). MATERIALS AND METHODS From November 2021 to December 2023, all patients with mechanical SBO who underwent contrast-enhanced DECT of the abdomen and pelvis were evaluated for inclusion. Demographic, clinical and biochemical data were collected. Two abdominal radiologists, blinded to all patient information, reviewed all DECT examinations. Conventional CT features (including a closed loop mechanism, mesenteric haziness, decreased bowel wall enhancement (DBE), and increased unenhanced attenuation of the bowel wall) were first reviewed on 70-keV-MR and 40-keV-MR, followed by BWIC measurements in five regions of interest in the walls of both normal and abnormal small bowel loops. The diagnostic performance of a simple CT score, which included a closed loop mechanism, mesenteric haziness and DBE, was compared to that of BWIC measurements made on dilated and/or abnormal small bowel segments for the diagnosis of small bowel ischemia. The diagnostic capabilities were compared using areas under the receiver operating characteristic curves (AUCs). RESULTS A total of 142 patients were included (80 men, 62 women; mean age, 67 ± 17 [standard deviation (SD)] years). Fifty-six patients underwent surgery; 22 of them had confirmed small bowel ischemia, including 12 patients with small bowel necrosis requiring surgical resection. Significant differences in mean BWIC were found between patients without small bowel ischemia (1.73 ± 0.44 [SD] mg/mL), those with small bowel ischemia without necrosis (0.79 ± 0.37 [SD] mg/mL), and those with small bowel ischemia and necrosis (0.48 ± 0.32 [SD] mg/mL) (P < 0.001). The overall AUC of the BWIC measurement for diagnosing small bowel ischemia was 0.98 (95 % confidence interval [CI]: 0.97-1.00), similar to the AUC of the simple CT score (0.97; 95 % CI: 0.92-1.00). However, using a cut off-value of 1.16 mgI/mL, BWIC outperformed subjective assessment of DBE at 70-keV-MR and 40-keV-MR (Youden index, 0.90 vs. 0.54 and vs. 0.71, respectively) (P < 0.001 for both). CONCLUSION BWIC measurement outperforms subjective assessment of DBE for the diagnosis of small bowel ischemia in patients with SBO and can allow stratification of ischemia. However, BWIC does not outperfomr a global comprehensive analysis of conventional CT images.
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Affiliation(s)
- Flora Lamant
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Gabriel Simon
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Andreas Busse-Coté
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Youness Hassoun
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Bastien Roussel
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Pierre Verdot
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25000 Besançon, France
| | - Paul Calame
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25000 Besançon, France.
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Reintam Blaser A, Koitmäe M, Laisaar KT, Forbes A, Kase K, Kiisk E, Murruste M, Reim M, Starkopf J, Tamme K. Radiological diagnosis of acute mesenteric ischemia in adult patients: a systematic review and meta-analysis. Sci Rep 2025; 15:9875. [PMID: 40119151 PMCID: PMC11928508 DOI: 10.1038/s41598-025-94846-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 03/17/2025] [Indexed: 03/24/2025] Open
Abstract
Computed tomography (CT) is widely used in diagnosing acute mesenteric ischemia (AMI), but robust identification of distinctive subtypes and stages of progression is lacking. Systematic literature search in PubMed, Cochrane Library, Web of Science and Scopus was conducted in May 2024. Studies including at least 10 adult patients and reporting radiological diagnosis of AMI versus no AMI or transmural ischemia versus no transmural ischemia were included. Meta-analyses on sensitivity and specificity of different radiological features in diagnosing AMI were conducted. From 2628 titles, 490 studies underwent full text review, and 81 were included in 14 meta-analyses. Diagnostic accuracy of CT angiography (CTA) was high - sensitivity of 92.0% and specificity of 98.8% (I2 45% and 79%, respectively), but lower for other CT protocols (sensitivity 75.8 and specificity 90.5; I2 83%). In most included studies, distinction of subtypes and severity of AMI (non-transmural or transmural) was not possible. Amongst the non-vascular features, absent/reduced bowel wall enhancement provided the best prognostic value (sensitivity 57.9 and specificity 90.1). CTA is the method of choice for diagnosing AMI with high diagnostic accuracy. None of the non-vascular features alone is sufficiently reliable to diagnose AMI or its progression to transmural necrosis, whereas a combination of different radiological features conveys a potential.
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Affiliation(s)
- Annika Reintam Blaser
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Merli Koitmäe
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Kaja-Triin Laisaar
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Alastair Forbes
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Karri Kase
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of General and Plastic Surgery, Tartu University Hospital, Tartu, Estonia
| | - Ele Kiisk
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Marko Murruste
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of General and Plastic Surgery, Tartu University Hospital, Tartu, Estonia
| | - Martin Reim
- Department of Radiology, Tartu University Hospital, Tartu, Estonia
| | - Joel Starkopf
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Kadri Tamme
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
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Räty P, Bonsdorff A, Parviainen H, Lantto E, Hackenberg T, Lampela H, Nykänen T, Lyytinen I, Mentula P, Sallinen V. Development and external validation of prediction risk scores (STRISK and NOFA) to predict immediate surgical need in adhesive small bowel obstruction: an observational prospective multicentre study. Br J Surg 2025; 112:znaf025. [PMID: 40105480 PMCID: PMC11921420 DOI: 10.1093/bjs/znaf025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 10/26/2024] [Accepted: 01/16/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Adhesive small bowel obstruction (SBO) is a common cause of emergency admission. Identification of patients at high risk of strangulation or failure of non-operative treatment is difficult. In this multicentre prospective observational study, prediction models for strangulation and non-operative treatment failure in adhesive SBO were developed. METHOD This study was carried out in three Finnish hospitals between June 2014 to May 2022. Patients with CT-confirmed adhesive SBO and prospective case report forms were included. The main outcomes were strangulation defined by operative finding of any intestinal ischaemia and failure of non-operative treatment within 30 days from admission. The model was developed using binary logistic regression, internally validated by bootstrapping and then externally validated. RESULTS Of 626 patients, 481 were included; 355 patients formed the model development group and 126 formed the external validation group. Strangulation occurred in 58 (16%) patients and non-operative treatment failed in 93 (31%) patients in development cohort. The following six variables were included in the risk model for strangulation and non-operative treatment failure: neutrophil-leucocyte ratio, number of previous SBOs, abdominal guarding, mesenteric changes and free abdominal fluid, closed loop sign, and faeces sign on CT. In the development cohort, the optimism corrected area under the receiver operator characteristics curve for the strangulation model was 0.860 (95% c.i. 0.808-0.917), and 0.751 (95% c.i. 0.694-0.816) for the non-operative treatment failure model respectively. At external validation, the models retained their discrimination and demonstrated stable calibration. CONCLUSION A clinically relevant prediction model to predict strangulation and non-operative treatment failure in adhesive small bowel obstruction has been developed.
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Affiliation(s)
- Panu Räty
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Akseli Bonsdorff
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Helka Parviainen
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eila Lantto
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Hanna Lampela
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Taina Nykänen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland
| | - Ilana Lyytinen
- Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Panu Mentula
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Vadot V, Guiraud A, Kalilou Sow A, Fournel I, Simon G, Acquier A, Mvouama S, Chevallier O, Ortega-Deballon P, Loffroy R. External validation of a CT score for predicting ischaemia in adhesive small-bowel obstruction. Eur Radiol 2025:10.1007/s00330-025-11362-1. [PMID: 39853337 DOI: 10.1007/s00330-025-11362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/26/2024] [Accepted: 12/17/2024] [Indexed: 01/26/2025]
Abstract
OBJECTIVES To assess the diagnostic accuracy, in a validation cohort, of a score based on three CT items, which has shown good performance for predicting ischaemia complicating acute adhesive small-bowel obstruction (SBO). METHODS This retrospective single-centre study of diagnostic accuracy included consecutive patients admitted for acute adhesive SBO in 2015-2022, who were treated conservatively or underwent surgery within 24 h after CT. The gold standard for ischaemia was an intraoperative diagnosis for operated patients, while the absence of ischaemia was confirmed either by its absence during surgery or by clinical follow-up in patients who did not undergo surgery. Three radiologists independently assessed the three score items, namely, decreased bowel-wall enhancement, diffuse mesenteric haziness, and closed-loop mechanism. Inter-observer agreement was evaluated by computing Fleiss' kappa. The diagnostic performance characteristics of the score were computed. RESULTS Of the 164 patients analysed (median age, 70 [57-80] years; 88 [54%] males), 57 (34.8%) had surgery, including 41 (71.9%) with intra-operative evidence of bowel ischaemia, whereas 107 (65.2%) were treated conservatively. A score ≥ 2/3 had a sensitivity of 78% (95% CI: 62-89%), a specificity of 97% (95% CI: 92-99%), a positive predictive value of 89% (95% CI: 74-97%), and a positive likelihood ratio of 24 (95% CI: 9.03-63.79). Adding increased unenhanced bowel-wall attenuation and requiring ≥ 2/4 items did not improve score performance. Fleiss' kappa values indicated moderate to substantial agreement between observers: 0.64 [0.56-0.73] for decreased bowel-wall enhancement, 0.57 [0.48-0.66] for diffuse mesenteric haziness, and 0.68 [0.59-0.76] for closed-loop mechanism. CONCLUSIONS The results of this external validation study support the reproducibility and good diagnostic performance of the score based on three CT items for predicting bowel ischaemia complicating acute adhesive SBO. KEY POINTS Question The Millet score with three enhanced CT items for predicting bowel ischaemia complicating acute adhesive SBO has not been assessed in an external validation cohort. Findings Adding "increased unenhanced bowel-wall attenuation" to the "decreased bowel-wall enhancement", "diffuse mesenteric haziness", and "closed-loop mechanism" items did not improve score performance. Clinical relevance In an external validation cohort, a score based on three CT items performed well for predicting ischaemia in patients with acute adhesive SBO and showed acceptable inter-observer agreement. This score may help identify patients for surgery.
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Affiliation(s)
- Valentin Vadot
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Adeline Guiraud
- Department of Abdominal and Visceral Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Amadou Kalilou Sow
- INSERM, CIC 1432, Clinical Epidemiology Module, François-Mitterrand University Hospital, University of Burgundy, Dijon, France
| | - Isabelle Fournel
- INSERM, CIC 1432, Clinical Epidemiology Module, François-Mitterrand University Hospital, University of Burgundy, Dijon, France
| | - Gabriel Simon
- Department of Body Imaging, Jean-Minjoz University Hospital, Besançon University Hospital, Besançon, France
| | - Adrien Acquier
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Ségolène Mvouama
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Abdominal and Visceral Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Romaric Loffroy
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France.
- ICMUB Laboratory, UMR CNRS 6302, Dijon, France.
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Zhao W, Xun J, Yuan X, Huang J, Bai J. Efficacy of traditional Chinese medicine in the conservative management of complete small intestinal obstruction post-gastric cancer surgery: A case report. Explore (NY) 2025; 21:103080. [PMID: 39577394 DOI: 10.1016/j.explore.2024.103080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 11/09/2024] [Indexed: 11/24/2024]
Abstract
In this case report, we describe the successful treatment of a patient with complete small bowel obstruction following gastric cancer surgery, employing an integrated approach of traditional Chinese medicine and Western medicine. Initial treatment consisted of conventional biomedical interventions, including intestinal obstruction catheterization, but after 16 days without improvement, surgical intervention was recommended. The patient, however, refused surgery and opted for treatments based on traditional Chinese medicine. Comprehensive traditional Chinese medicine therapies such as acupuncture, moxibustion, flash cupping, oral administration of compound herbal formulas, and enemas using Chinese herbal medicine were implemented alongside modern medical care. The obstruction resolved, and the patient was discharged without requiring surgery. Follow-up revealed no recurrence of the condition. This case highlights the potential of integrating traditional Chinese medicine with Western medical practices in the conservative management of complete small bowel obstruction, offering a reference for clinical application.
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Affiliation(s)
- Weipeng Zhao
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
| | - Jian Xun
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
| | - Xinyu Yuan
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Jinchang Huang
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Jing Bai
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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10
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Zhu Y, Wang Q, Cao L, Zhang T, Chang J, Wang X. Development and validation of a nomogram model to predict the risk of strangulated intestinal obstruction. Sci Rep 2024; 14:31049. [PMID: 39730785 PMCID: PMC11681171 DOI: 10.1038/s41598-024-82131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 12/03/2024] [Indexed: 12/29/2024] Open
Abstract
To develop and validate a nomogram model for discriminating simple intestinal obstruction and strangulated intestinal obstruction, thus providing objective evidence for clinical decision-making. Following pre-established inclusion and exclusion criteria, a retrospective analysis was conducted on the clinical data of 560 patients diagnosed with intestinal obstruction who were admitted to the Emergency Surgery Department of the First Affiliated Hospital of Anhui Medical University between January 1, 2020, and December 31, 2022. The data was subsequently split into a training cohort (n = 393) and a validation cohort (n = 167) using a 7:3 ratio. To identify independent risk and protective factors associated with strangulated intestinal obstruction, a multivariate logistic regression analysis was employed. Based on the identified factors, a nomogram prediction model was constructed. The model's discriminatory ability was assessed using the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and the corrected C-index. The Hosmer-Lemeshow test was utilized to evaluate the model's goodness of fit in both the training and validation cohorts. Calibration curves were generated to assess the model's accuracy in predicting the probability of strangulated intestinal obstruction. Finally, decision curve analysis (DCA) was performed to evaluate the model's potential clinical utility. Multivariate logistic regression analysis identified neutrophil percentage, peritoneal irritation sign, and abdominal fluid as independent risk factors for strangulated intestinal obstruction, while albumin emerged as an independent protective factor. These factors were incorporated into the nomogram, demonstrating high discrimination (AUC of 0.842[95%CI: 0.787-0.897] in the training set and 0.839 [95%CI: 0.742-0.937] in the validation set) and good calibration. The corrected C-index further supported the model's performance in the training (0.833) and validation (0.813) cohorts. The Hosmer-Lemeshow test results (p = 0.759 and p = 0.505, respectively) indicated a good model fit in both cohorts. Calibration curves confirmed the close agreement between the nomogram predictions and actual observations. Finally, DCA corroborated the model's net clinical benefit. The comprehensive nomogram developed in this study emerged as a promising and convenient tool for evaluating the risk of strangulated intestinal obstruction, thereby aiding clinicians in screening the high-risk population.
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Affiliation(s)
- Yanjing Zhu
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Qiangqiang Wang
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Lvhao Cao
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Tongyuan Zhang
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Jiawei Chang
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Xingyu Wang
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China.
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11
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Pan S, Yang J, Liu Z, Nai R, Chen Z. A prediction model to differentiate transient ischemia from irreversible transmural necrosis in closed-loop small bowel obstruction. Front Med (Lausanne) 2024; 11:1466754. [PMID: 39323473 PMCID: PMC11422149 DOI: 10.3389/fmed.2024.1466754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024] Open
Abstract
Introduction The study aims to develop a prediction model to differentiate transient ischemia from irreversible transmural necrosis in closed-loop small bowel obstruction (CL-SBO). Methods A total of 180 participants with CL-SBO between January 2010 and December 2019, of which 122 had complete radiologic data, were included to investigate the significant clinical and imaging characteristics for differentiating patients with necrosis from transient ischemia. A logistic regression model was developed and validated. Results In a multivariate analysis, the American Society of Anesthesiologists physical status classification system >2 is the independent predictor for transmural necrosis. Another multivariate analysis, including clinical and imaging factors, revealed that the imaging sign of mesenteric vessel interruption was an independent risk factor for necrosis. The diagnostic model developed using these two factors has excellent performance among the validation sets, with an area under the curve of 0.89. Conclusion The diagnostic model and innovative imaging signs have substantial potential in solving this complex clinical problem.
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Affiliation(s)
- Shaorong Pan
- Department of Gastrointestinal Surgery, Peking University First Hospital, Peking University, Beijing, China
| | - Jiejin Yang
- Department of Radiology, Peking University First Hospital, Peking University, Beijing, China
| | - Zining Liu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rile Nai
- Department of Radiology, Peking University First Hospital, Peking University, Beijing, China
| | - Zeyang Chen
- Department of Gastrointestinal Surgery, Peking University First Hospital, Peking University, Beijing, China
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12
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Zhou Y, Zhao H, Liu B, Qian J, Chen N, Wang Y, Tu D, Chen X, Li H, Zhang X. The value of D-dimer and platelet-lymphocyte ratio combined with CT signs for predicting intestinal ischemia in patients with bowel obstruction. PLoS One 2024; 19:e0305163. [PMID: 38976662 PMCID: PMC11230572 DOI: 10.1371/journal.pone.0305163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/26/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE To investigate the diagnostic value of D-dimer, platelet-lymphocyte rate (PLR) and CT signs for intestinal ischemia in patients with bowel obstruction. METHODS We retrospectively analyzed the clinical and imaging data of 105 patients diagnosed with bowel obstruction, and performed univariate and multivariate analyses to determine the independent risk factors for intestinal ischemia in patients with bowel obstruction. Moreover, the receiver operating characteristic curve (ROC) was plotted to examine the diagnostic value of D-dimer, PLR and CT signs in patients with bowel obstruction. Besides, Kappa tests were used to assess inter-observer agreement. RESULTS We included 56 men (53%) and 49 women (47%) with mean age of 66.05 ± 16 years. Univariate and multivariate analyses showed that D-dimer, PLR and two significant CT signs (i.e., increased unenhanced bowel-wall attenuation and mesenteric haziness) were independent risk factors for intestinal ischemia in patients with bowel obstruction. ROC analysis showed that the combined use of D-dimer, PLR and the said two CT signs had better performance than single indicators in predicting intestinal ischemia in patients with bowel obstruction. The area under the curve (AUC) of the joint model III was 0.925 [95%CI: 0.876-0.975], with a sensitivity of 79.2% [95CI%: 67.2-91.1] and a specificity of 91.2% [95%CI: 83.7-98.9]. CONCLUSION The combined use of D-dimer, PLR and CT signs has high diagnostic value for intestinal ischemia in patients with bowel obstruction and will prompt surgical exploration to evaluate intestinal blood flow.
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Affiliation(s)
- Yuan Zhou
- Xuzhou Medical University, Xuzhou, China
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Haijian Zhao
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Bing Liu
- Xuzhou Medical University, Xuzhou, China
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Jiangfeng Qian
- Xuzhou Medical University, Xuzhou, China
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Ning Chen
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Yan Wang
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Daoyuan Tu
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Xiaoyu Chen
- Department of Radiology, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Heng Li
- Department of Pathology, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
| | - Xiaoyu Zhang
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
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13
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Kurian J, Winant AJ, Hull NC, Lee EY. Pediatric Acute Abdomen: Bread-and-Butter Diagnoses. Semin Roentgenol 2024; 59:312-331. [PMID: 38997184 DOI: 10.1053/j.ro.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Jessica Kurian
- Department of Radiology, Westchester Medical Center, Valhalla, NY.
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
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14
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Friziero A, Rosso E, Zuin IS, Vallese L, Serafini S, Amico A, Valli V, Re CD, Baldan N, Valmasoni M, Dalt GD, Sperti C. Neutrophil to lymphocyte ratio predicts bowel ischemia in non-strangulated adhesive small bowel occlusions: a retrospective analysis from an acute care surgical service. BMC Surg 2024; 24:179. [PMID: 38867261 PMCID: PMC11167870 DOI: 10.1186/s12893-024-02476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/07/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Adhesive small bowel obstruction (ASBO) is a leading cause of hospitalization in emergency surgery. The occurrence of bowel ischemia significantly increases the morbidity and mortality rates associated with this condition. Current clinical, biochemical and radiological parameters have poor predictive value for bowel ischemia. This study is designed to ascertain predictive elements for the progression to bowel ischemia in patients diagnosed with non-strangulated ASBO who are initially managed through conservative therapeutic approaches. METHODS The study was based on the previously collected medical records of 128 patients admitted to the Department of Acute Care Surgery of Padua General Hospital, from August 2020 to April 2023, with a diagnosis of non-strangulated adhesive small bowel obstruction, who were then operated for failure of conservative treatment. The presence or absence of bowel ischemia was used to distinguish the two populations. Clinical, biochemical and radiological data were used to verify whether there is a correlation with the detection of bowel ischemia. RESULTS We found that a Neutrophil-Lymphocyte ratio (NLR) > 6.8 (OR 2.9; 95% CI 1.41-6.21), the presence of mesenteric haziness (OR 2.56; 95% CI 1.11-5.88), decreased wall enhancement (OR 4.3; 95% CI 3.34-10.9) and free abdominal fluid (OR 2.64; 95% CI 1.08-6.16) were significantly associated with bowel ischemia at univariate analysis. At the multivariate logistic regression analysis, only NLR > 6.8 (OR 5.9; 95% CI 2.2-18.6) remained independent predictive factor for small bowel ischemia in non-strangulated adhesive small bowel obstruction, with 78% sensitivity and 65% specificity. CONCLUSIONS NLR is a straightforward and reproducible parameter to predict bowel ischemia in cases of non-strangulated adhesive small bowel obstruction. Employing NLR during reevaluation of patients with this condition, who were initially treated conservatively, can help the acute care surgeons in the early prediction of bowel ischemia onset.
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Affiliation(s)
- Alberto Friziero
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Eugenia Rosso
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Irene Sole Zuin
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Lorenzo Vallese
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Simone Serafini
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Alessandra Amico
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Valeria Valli
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Chiara Da Re
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Nicola Baldan
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Michele Valmasoni
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Gianfranco Da Dalt
- Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Cosimo Sperti
- Department of Surgery, Oncology and Gastroenterology, 2nd Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy.
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15
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Eze VN, Parry T, Boone D, Mallett S, Halligan S. Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review. Eur Radiol 2024; 34:3861-3871. [PMID: 37938387 PMCID: PMC11166786 DOI: 10.1007/s00330-023-10421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/06/2023] [Accepted: 09/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction. METHODS Two researchers systematically reviewed indexed literature 2001-2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies. RESULTS Thirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36). CONCLUSIONS Systematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery. CLINICAL RELEVANCE STATEMENT Via systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility. KEY POINTS • While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely. • Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery. • Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility.
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Affiliation(s)
- Vivienne N Eze
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Tom Parry
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Darren Boone
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
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16
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Talwar G, McKechnie T, Patel J, Qiu R, Wu K, Lee Y, Hong D, Doumouras A, Bogach J, Eskicioglu C. Assessing the Modified Frailty Index and Post-Operative Outcomes in Adhesive Small Bowel Obstruction: A Retrospective Cohort Study. J Surg Res 2024; 297:71-82. [PMID: 38447338 DOI: 10.1016/j.jss.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/18/2023] [Accepted: 12/16/2023] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Studies identifying predictors of postoperative outcomes in adhesive small bowel obstruction are limited. This study investigates the efficacy of the modified frailty index (mFI)to predict postoperative morbidity and mortality among patients undergoing surgery for adhesive small bowel obstruction. METHODS A multicentre retrospective cohort study including patients undergoing surgery for adhesive small bowel obstruction after failed trial of nonoperative management between January 2015 and December 2020 was performed. Impact of frailty status using the mFI, stratified as frail (≥0.27) and robust (<0.27), on postoperative morbidity, mortality, length of stay, and discharge destination was evaluated using multiple logistic regression. RESULTS Ninety-two robust patients (mean age 62.4 y, 68% female) and 41 frail patients (mean age 81.7 y, 63% female) were included. On simple stratification, frail patients had significantly increased 30-d morbidity (overall morbidity 80% versus 49%) and need for higher level of care on discharge (41% versus 9%). However, on multiple regression, functional dependence but not the mFI, was independently associated with worse 30-d overall morbidity (odds ratio [OR] 3.97, confidence interval [CI] 1.29-12.19) and lower likelihood of returning to preoperative disposition (OR 0.21, CI 0.05-0.91). The delay in operation beyond 5 d was independently associated with worse 30-d outcomes including overall morbidity and mortality (OR 7.54, CI 2.13-26.73) and decreased return to preoperative disposition (OR 0.14, CI 0.04-0.56). CONCLUSIONS The mFI, although promising, was not independently predictive of outcomes following surgery for adhesive small bowel obstruction. Further adequately powered studies are required.
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Affiliation(s)
- Gaurav Talwar
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Janhavi Patel
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Reva Qiu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Wu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jessica Bogach
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, Juravinski Hospital, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
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17
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Wang H, Zhang JR, Tu PS, Chen WX, Chen S, Chen QF, Weng ZQ, Shang-Guan XC, Lin BQ, Chen XQ. Comparison of the effect between traditional conservation and nasointestinal tube placement in adhesive small bowel obstruction: A matched case-control study. Asian J Surg 2024; 47:2168-2177. [PMID: 38461140 DOI: 10.1016/j.asjsur.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/11/2024] Open
Abstract
Adhesive small bowel obstruction (ASBO) causes a major burden in emergency medicine. Owing to in situ decompression, nasointestinal tube (NIT) placement has been increasingly used in clinical practice compared with traditional conservation (TC); however, the indications remain controversial. This study was designed to explore the indications for each treatment in ASBOs and then suggest the optimal strategy. After propensity score matching, 128 pairs were included (the NIT and TC groups). The occurrence of severe adverse events (SAEs), peri-treatment clinical parameters, and radiological features were compared between the successful and failed treatment groups. According to different stages of the entire treatment, the independent risk factors for adverse effects for ASBO were analysed in phase I and phase II. In phase I, normal red blood cells (RBC) levels (p = 0.011) and a balanced sodium ion level (p = 0.016) positively affected the outcomes of TC treatment. In phase II, for the TC group, the successful treatment rate reached 79.5% for patients with ASBOs whose normal RBC levels (p = 0.006) or decreasing white blood cells (WBC) levels (p = 0.014) after treatment. For the NIT group, the treatment success rate was 68.1% for patients whose electrolyte imbalance could be reversed or whose neutrophil count/lymphocyte ratio (NLR) levels was lower than 4.3 (p = 0.018). TC treatment is highly recommended for patients with normal RBC counts and sodium levels pretreatment. After dynamic monitoring of the treatment process, for both the TC and NIT groups, once ASBOs had elevated inflammatory biomarkers or irreversible electrolyte disturbances, surgical interference was preferred.
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Affiliation(s)
- Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Jun-Rong Zhang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Peng-Sheng Tu
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Wen-Xuan Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Qing-Feng Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Zong-Qi Weng
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xin-Chang Shang-Guan
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Bing-Qiang Lin
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xian-Qiang Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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18
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Li BQ, Qi WJ, Yuan M, Wang HY, Chen M, Lei JA, Meng M, Li Q, Li L, Jiang B, Ma ZL, Xiu DR, Yuan CH. Prediction of bowel necrosis by reduced bowel wall enhancement in closed-loop small bowel obstruction: Quantitative methods. Eur J Radiol 2024; 173:111363. [PMID: 38367415 DOI: 10.1016/j.ejrad.2024.111363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE To assess diagnostic performance and reproducibility of reduced bowel wall enhancement evaluated by quantitative methods using CT to identify bowel necrosis among closed-loop small bowel obstruction (CL-SBO) patients. METHODS This retrospective single-center study included patients who diagnosed with CL-SBO caused by adhesion or internal hernia during January 2016 and May 2022. Patients were divided into necrotic group (n = 41) and non-necrotic group (n = 67) according to surgical exploration and postoperative pathology. Two doctors independently measured the attenuation of bowel wall and consensus was reached through panel discussion with a third gastrointestinal radiologist. Reduced bowel wall enhancement was assessed by four quantitative methods. Univariate analyses were used to evaluate the association between each method and bowel necrosis, and kappa/intraclass correlation coefficient values were used to assess interobserver agreement. Diagnostic performance parameters were calculated for each method. RESULTS Reduced bowel wall enhancement in arterial phase (OR 8.98, P < 0.0001), reduced bowel wall enhancement in portal phase (OR 16.84, P < 0.001), adjusted reduced bowel wall enhancement in arterial phase (OR 29.48, P < 0.001), adjusted reduced bowel wall enhancement in portal phase (OR 145.69, P < 0.001) were significantly associated with bowel necrosis. Adjusted reduced bowel wall enhancement in portal phase had the best diagnostic performance (AUC: 0.92; Youden index: 0.84; specificity: 94.03 %) and interobserver agreement (kappa value of 0.59-0.73) to predict bowel necrosis. CONCLUSION When assessing reduced bowel enhancement to predict bowel necrosis among CL-SBO patients, using unenhanced CT images and proximal dilated loop as standard references in portal phase is the most accurate quantitative method among those tested.
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Affiliation(s)
- Bing-Qi Li
- Department of General Surgery, Peking University Third Hospital, Beijing, China; Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China
| | - Wei-Jun Qi
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Meng Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Hang-Yan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Ming Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ji-An Lei
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Meng Meng
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Qi Li
- Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China
| | - Lei Li
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Bin Jiang
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Zhao-Lai Ma
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Dian-Rong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Chun-Hui Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing, China.
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Talwar G, McKechnie T, Lee Y, Kazi T, El-Sayes A, Bogach J, Hong D, Eskicioglu C. Modified frailty index predicts postoperative morbidity in adhesive small bowel obstruction: analyzing the National Inpatient Sample 2015-2019. J Gastrointest Surg 2024; 28:205-214. [PMID: 38445910 DOI: 10.1016/j.gassur.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/08/2023] [Accepted: 10/25/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND There are limited data identifying predictors of postoperative outcomes in adhesive small bowel obstruction (ASBO). This study used the National Inpatient Sample (NIS) to assess the efficacy of the modified frailty index (mFI) to predict postoperative morbidity among patients undergoing an operation for ASBO. METHODS A retrospective analysis of the NIS between September 1, 2015, and December 31, 2019, was performed to identify adult patients who underwent nonelective operative intervention for ASBO. The mFI was used to stratify patients as either frail (mFI value ≥ 0.27) or robust (mFI value < 0.27). The primary outcomes were overall in-hospital postoperative morbidity and mortality. The secondary outcomes were system-specific morbidity, length of stay (LOS), total in-hospital healthcare cost, and discharge disposition. Univariable and multivariable regressions were used. RESULTS Overall, 23251 robust patients and 6122 frail patients were included. Adjusted analyses demonstrated that frail patients had increased in-hospital mortality (adjusted odds ratio [aOR], 2.16; 95% CI, 1.80-2.60), postoperative morbidity (aOR, 1.63; 95% CI, 1.52-1.74), postoperative LOS (adjusted mean difference [aMD], 0.97 days; 95% CI, 0.73-1.21), and total in-hospital healthcare costs (aMD, $18,921; 95% CI, $14,608-$23,235) and were less likely to be discharged home (aOR, 0.59; 95% CI, 0.55-0.63). The findings were unchanged on subgroup analysis of patients undergoing open operation and those older than 65 years of age. CONCLUSION The mFI may predict postoperative outcomes for ASBO. Stratifying patients based on frailty may assist clinicians and patients in making informed decisions, setting realistic expectations, and proactively planning postoperative disposition.
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Affiliation(s)
- Gaurav Talwar
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tania Kazi
- Faculty of Health Sciences Undergraduate Medical Education, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Abdullah El-Sayes
- Faculty of Health Sciences Undergraduate Medical Education, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Bogach
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, Juravinski Hospital, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
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20
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Li BQ, Qi WJ, Yuan M, Wang HY, Chen M, Song ZX, Li Q, Li L, Jiang B, Ma ZL, Xiu DR, Yuan CH. Increased Attenuation of Intestinal Contents at CT Indicates Bowel Necrosis in Closed-Loop Small Bowel Obstruction. Radiology 2024; 310:e231710. [PMID: 38319165 DOI: 10.1148/radiol.231710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Preoperative recognition of irreversible bowel necrosis is important, as it provides valuable guidance for surgical strategy selection but also may inform perioperative risk assessment and communication. Few studies have focused on the association between CT signs and bowel necrosis. Purpose To assess the diagnostic accuracy of CT signs to predict bowel necrosis in patients with closed-loop small bowel obstruction (CL-SBO). Materials and Methods This retrospective single-center study included patients who were surgically confirmed to have CL-SBO caused by adhesion or internal hernia between January 2016 and May 2022. Necrosis was determined based on surgical exploration and postoperative pathologic examination. Two radiologists independently reviewed CT signs by both subjective visual assessment and objective measurement. Disagreements were resolved in consensus with a third gastrointestinal radiologist. Univariable and multivariable analyses were used to assess the association between CT signs and bowel necrosis, and Cohen κ was used to assess interobserver agreement. Sensitivity and specificity were calculated for each CT sign. Results This study included 145 patients: 61 (42.1%) in the necrotic group (median age, 62 years [IQR, 51-71.5 years]; 37 [60.7%] women) and 84 (57.9%) in the nonnecrotic group (median age, 61.5 years [IQR, 51-68.8 years]; 51 [60.7%] women). Univariable analysis and multivariable analysis showed that increased attenuation of intestinal contents and increased attenuation of intestinal wall were independent predictors for bowel necrosis (odds ratio = 45.3 and 15.1; P = .001 and P < .001, respectively). Increased attenuation of intestinal contents and increased attenuation of intestinal wall had similar sensitivity (64% and 67%, respectively) and specificity (99% and 92%, respectively) for predicting bowel necrosis. However, interobserver agreement was better for assessing the contents than the wall (κ = 0.84 and 0.59, respectively). Conclusion Increased attenuation of intestinal contents was a highly specific CT sign with good reproducibility to predict bowel necrosis in CL-SBO. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Taourel and Zins in this issue.
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Affiliation(s)
- Bing-Qi Li
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Wei-Jun Qi
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Meng Yuan
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Hang-Yan Wang
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Ming Chen
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Zi-Xiu Song
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Qi Li
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Lei Li
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Bin Jiang
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Zhao-Lai Ma
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Dian-Rong Xiu
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
| | - Chun-Hui Yuan
- From the Departments of General Surgery (B.Q.L., W.J.Q., M.Y., H.Y.W., L.L., B.J., Z.L.M., D.R.X., C.H.Y.), Radiology (M.C.), and Pathology (Z.X.S.), Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing 100191, China; and Department of General Surgery, Yan'an Hospital of Traditional Chinese Medicine, Shanxi, China (B.Q.L., Q.L.)
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Oh S, Ryu J, Shin HJ, Song JH, Son SY, Hur H, Han SU. Deep learning using computed tomography to identify high-risk patients for acute small bowel obstruction: development and validation of a prediction model : a retrospective cohort study. Int J Surg 2023; 109:4091-4100. [PMID: 37720936 PMCID: PMC10720875 DOI: 10.1097/js9.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/19/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To build a novel classifier using an optimized 3D-convolutional neural network for predicting high-grade small bowel obstruction (HGSBO). SUMMARY BACKGROUND DATA Acute SBO is one of the most common acute abdominal diseases requiring urgent surgery. While artificial intelligence and abdominal computed tomography (CT) have been used to determine surgical treatment, differentiating normal cases, HGSBO requiring emergency surgery, and low-grade SBO (LGSBO) or paralytic ileus is difficult. METHODS A deep learning classifier was used to predict high-risk acute SBO patients using CT images at a tertiary hospital. Images from three groups of subjects (normal, nonsurgical, and surgical) were extracted; the dataset used in the study included 578 cases from 250 normal subjects, with 209 HGSBO and 119 LGSBO patients; over 38 000 CT images were used. Data were analyzed from 1 June 2022 to 5 February 2023. The classification performance was assessed based on accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS After fivefold cross-validation, the WideResNet classifier using dual-branch architecture with depth retention pooling achieved an accuracy of 72.6%, an area under receiver operating characteristic of 0.90, a sensitivity of 72.6%, a specificity of 86.3%, a positive predictive value of 74.1%, and a negative predictive value of 86.6% on all the test sets. CONCLUSIONS These results show the satisfactory performance of the deep learning classifier in predicting HGSBO compared to the previous machine learning model. The novel 3D classifier with dual-branch architecture and depth retention pooling based on artificial intelligence algorithms could be a reliable screening and decision-support tool for high-risk patients with SBO.
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Affiliation(s)
- Seungmin Oh
- Department of Artificial Intelligence, Ajou University, Suwon, South Korea
| | - Jongbin Ryu
- Department of Artificial Intelligence, Ajou University, Suwon, South Korea
- Department of Software and Computer Engineering, Ajou University, Suwon, South Korea
| | - Ho-Jung Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jeong Ho Song
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
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22
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Maienza E, Godiris-Petit G, Noullet S, Menegaux F, Chereau N. Management of adhesive small bowel obstruction: the results of a large retrospective study. Int J Colorectal Dis 2023; 38:224. [PMID: 37668744 PMCID: PMC10480247 DOI: 10.1007/s00384-023-04512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Postoperative adhesive small bowel obstruction (SBO) is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive SBO can be managed nonoperatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive SBO. Treatment recommendations are still controversial. METHODS We conducted an observational retrospective monocentric study to test our protocol of management of SBO using Gastrografin®, enrolling 661 patients from January 2008 to December 2021. An emergency surgery was performed in patients with abdominal tenderness, peritonitis, hemodynamic instability, major acute abdominal pain despite gastric decompression, or CT scan findings of small bowel ischemia. Nonoperative management was proposed to patients who did not need emergency surgery. A gastric decompression with a nasogastric tube was immediately performed in the emergency room for four hours, then the nasogastric tube was clamped and 100 ml of nondiluted oral Gastrografin® was administered. The nasogastric tube remained clamped for eight hours and an abdominal plain radiograph was taken after that period. Emergency surgery was then performed in patients who had persistent abdominal pain, onset of abdominal tenderness or vomiting during the clamping test, or if the abdominal plain radiograph did not show contrast product in the colon or the rectum. In other cases, the nasogastric tube was removed and a progressive refeeding was introduced, starting with liquid diet. RESULTS Seventy-eight percent of patients with SBO were managed nonoperatively, including 183 (36.0%) who finally required surgery. Delayed surgery showed a complete small bowel obstruction in all patients who failed the conservative treatment, and a small bowel resection was necessary in 19 patients (10.0%): among them, only 5 had intestinal ischemia. CONCLUSIONS Our protocol is safe, and it is a valuable strategy in order to accelerate the decision-making process for management of adhesive SBO, with a percentage of risk of late small bowel resection for ischemia esteemed at 0.9%.
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Affiliation(s)
- E Maienza
- Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, Sorbonne University Paris, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - G Godiris-Petit
- Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, Sorbonne University Paris, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - S Noullet
- Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, Sorbonne University Paris, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - F Menegaux
- Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, Sorbonne University Paris, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - N Chereau
- Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, Sorbonne University Paris, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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23
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Nielsen LBJ, Ærenlund MP, Alouda M, Azzam M, Bjerke T, Burcharth J, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Malik T, Ngo-Stuyt L, Nielsen EØ, Olausson M, Skovsen AP, Tolver MA, Smith HG. Real-world accuracy of computed tomography in patients admitted with small bowel obstruction: a multicentre prospective cohort study. Langenbecks Arch Surg 2023; 408:341. [PMID: 37642708 PMCID: PMC10465641 DOI: 10.1007/s00423-023-03084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Small bowel obstruction (SBO) is a common surgical emergency. Previous studies have shown the value computed tomography (CT) scanning in both confirming this diagnosis and identifying indications for urgent surgical intervention, such as strangulated bowel or closed loop obstructions. However, most of the literature is based on retrospective expert review of previous imaging and little data regarding the real-time accuracy of CT reporting is available. Here, we investigated the real-world accuracy of CT reporting in patients admitted with SBO. METHODS This was a multicentre prospective study including consecutive patients admitted with SBO. The primary outcomes were the sensitivity and specificity of CT scanning for bowel obstruction with ischaemia and closed loop obstruction. Data were retrieved from the original CT reports written by on-call radiologists and compared with operative findings. RESULTS One hundred seventy-six patients were included, all of whom underwent CT scanning with intravenous contrast followed by operative management of SBO. Bowel obstruction with ischaemia was noted in 20 patients, with a sensitivity and specificity of CT scanning of 40.0% and 85.5%, respectively. Closed loop obstructions were noted in 26 patients, with a sensitivity and specificity of CT scanning of 23.1% and 98.0%, respectively. CONCLUSIONS The real-world accuracy of CT scanning appears to be lower than previously reported in the literature. Strategies to address this could include the development of standardised reporting schemas and to increase the surgeon's own familiarity with relevant CT features in patients admitted with SBO.
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Affiliation(s)
- L B J Nielsen
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - M P Ærenlund
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Alouda
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - J Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Malik
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Olausson
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - H G Smith
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.
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Jaidee W, Teerasamit W, Apisarnthanarak P, Kongkaewpaisan N, Panya S, Kaewlai R. Small bowel transmural necrosis secondary to acute mesenteric ischemia and strangulated obstruction: CT findings of 49 patients. Heliyon 2023; 9:e17543. [PMID: 37519715 PMCID: PMC10372211 DOI: 10.1016/j.heliyon.2023.e17543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
Rationale and objectives Transmural bowel necrosis (TBN) is an uncommon surgical emergency that represents an endpoint of occlusive acute mesenteric ischemia (AMI), nonocclusive AMI and small bowel obstruction (SBO). According to limited evidence, each etiology of TBN might demonstrate a different CT finding. This investigation aimed to 1) identify overall CT findings of TBN, and 2) compare CT findings of TBN in each etiology. Materials and methods Forty-nine consecutive adults (mean age, 64.6 years; 26 men) with occlusive AMI, nonocclusive AMI or SBO, and pathologically proven TBN were enrolled. All had a CT scan within 24 h before surgery. Clinical information was compiled from medical records. CT examinations were re-reviewed by two radiologists with disagreements resolved by the third radiologist. Data were analyzed and compared. Results Transmural bowel necrosis were secondary to arterial AMI, venous AMI, combined arterial and venous AMI, nonocclusive AMI, and SBO in 6, 5, 2, 10, and 26 patients, respectively. The CT findings were ascites (93.9%), abnormal wall enhancement (91.8%), bowel dilatation (89.8%), mesenteric fat stranding (89.8%), abnormal wall thickness (71.5%), pneumatosis (46.9%) and intrinsic hyperattenuation of bowel walls (22.5%). Portovenous gas, mesenteric venous gas, and pneumoperitoneum were present in 4 patients (8.2%). Bowel wall thickness was the only CT findings that showed a statistically significant difference among the 5 etiologies of TBN (P = 0.046). Conclusions Most common CT findings of TBN were ascites, abnormal bowel wall enhancement, dilatation, and mesenteric fat stranding. Wall thickness differentiated five etiologies, being most thickened in venous AMI and normal in arterial AMI.
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Affiliation(s)
- Watanya Jaidee
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanwarang Teerasamit
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyaporn Apisarnthanarak
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Napaporn Kongkaewpaisan
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirinya Panya
- Department of Surgery, Faculty of Medicine Burapha University, Chonburi, Thailand
| | - Rathachai Kaewlai
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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25
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Liu X, Zhu M, Wu M, Cheng Z, Wu X, Zhu R. Unenhanced CT-based predictive model to identify small bowel necrosis in patients with mechanical small bowel obstruction. BMC Med Imaging 2023; 23:80. [PMID: 37308879 DOI: 10.1186/s12880-023-01041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES To investigate the diagnostic value of unenhanced CT in mechanical small bowel obstruction (SBO) with small bowel necrosis, and to establish a predictive model. METHODS From May 2017 to December 2021, the patients with mechanical SBO admitted to our hospital were retrospectively collected. Taking pathology-confirmed small bowel necrosis as the gold standard, the experimental group was composed of patients with small bowel necrosis confirmed by pathology, and the control group was composed of patients with no intestinal necrosis confirmed by surgery or successful conservative treatment with no recurrence of intestinal obstruction during 1-month followed-up. RESULTS A total of 182 patients were enrolled in this study, 157 patients underwent surgery, of which 35 patients were accompanied with small bowel necrosis and 122 patients were not (33 patients with ischemic findings at surgery without necrosis). Finally, there were 35 patients in the experimental group and 147 patients in the control group. Multivariable logistic regression showed that increased attenuation of small bowel wall (P = 0.002), diffuse mesenteric haziness (P = 0.010), difference of CT value between mesenteric vessel and aorta (P = 0.025) and U-/C-shaped small bowel loop (P = 0.010) were independent risk factors for the diagnosis of mechanical SBO with small bowel necrosis. Through internal verification, the area under curve (AUC) of the predictive model reached 0.886 (95%CI: 0.824-0.947), and the calibration result was moderate. CONCLUSION Multiple features (increased attenuation of small bowel wall; difference of CT values between mesenteric vessel and aorta; diffuse mesenteric haziness; and U-/C-shaped small bowel loop) of unenhanced CT have clinical value in the diagnosis of mechanical SBO with small bowel necrosis. The predictive model based on these four features could achieve satisfactory efficiency.
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Affiliation(s)
- Xianwei Liu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China.
| | - MingJie Zhu
- Department of Gastrointestinal Surgery, The People's Hospital of Leshan, Sichuan province, Leshan, China
| | - Ming Wu
- Department of Image Center, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, China
| | - Zhangsong Cheng
- Department of Image Center, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, China
| | - Xiaoyu Wu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China
| | - Renfang Zhu
- Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China
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Kim HR, Lee Y, Kim J, Baek TW, Kim H, Son JH, Park EJ, Kim SH. Closed loop obstruction of small bowel: CT signs predicting successful non-surgical treatment. Eur J Radiol 2023; 161:110716. [PMID: 36758277 DOI: 10.1016/j.ejrad.2023.110716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/04/2022] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To clarify the computed tomography (CT) findings related to successful conservative treatments in patients with closed-loop small bowel obstruction (CL-SBO) without evidence of bowel strangulation. METHODS Sixty-four patients (71 CT scans) diagnosed with CL-SBO by CT and received initial conservative treatments from May 2010 to August 2020 were retrospectively included. Two blinded radiologists reviewed the CT findings, including the transition zone (number, distance, and location), maximum bowel diameter, mesenteric haziness, mesenteric fluid, increased unenhanced bowel wall attenuation, decreased bowel wall enhancement, small bowel feces sign, whirl sign, bowel wall thickening, ascites, and degree of obstruction. The findings of the success and failure groups of conservative treatment were compared. Interobserver agreement was assessed for all findings. RESULTS Among the 71 cases, conservative treatments were successful in 42 cases (59 %) but failed in 29 cases (41 %). In multivariable analyses, the distance between the transition zones (>1 cm) and low-degree obstruction were independently associated with successful conservative treatments, with odds ratios of 6.23 and 3.52, respectively. The combination of these two CT findings exhibited a specificity of 89.7 % with a positive likelihood ratio of 3.01. Interobserver agreement of the degree of obstruction and the distance between the transition zones was almost perfect (ĸ = 0.814 and 0.914, respectively). CONCLUSIONS The distance between the transition zones (>1 cm) and low-grade obstruction are independent CT predictors of successful conservative treatments in CL-SBO patients. Initial conservative treatments are recommended for patients with both CT findings.
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Affiliation(s)
- Hye Ri Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Yedaun Lee
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea.
| | - Jieun Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Tae Wook Baek
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Hyunwoong Kim
- Clinical Trial Center, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Jung Hee Son
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Eun Joo Park
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
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Gómez Corral J, Niño Rojo C, de la Fuente Olmos R. Bowel obstruction: signs indicating the need for urgent surgery. RADIOLOGIA 2023; 65 Suppl 1:S92-S98. [PMID: 37024235 DOI: 10.1016/j.rxeng.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/11/2022] [Indexed: 04/08/2023]
Abstract
Bowel obstruction is common in emergency departments. Obstruction is more common in the small bowel than in the large bowel. The most common cause is postsurgical adhesions. Nowadays, bowel obstruction is diagnosed with multidetector computed tomography (MDCT). MDCT studies for suspected bowel obstruction should focus on four points that need to be mentioned in the report: confirming the obstruction, determining whether there is a single transition point or whether the obstruction is found in a closed loop, establishing the cause of the obstruction, and seeking signs of complications. Identifying signs of ischemia is important in the management of the patient because it enables patients at higher risk of poor outcomes after conservation treatment who could benefit from early surgical intervention to avoid greater morbidity and mortality associated with strangulation and ischemia of the obstructed bowel loop.
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Affiliation(s)
- J Gómez Corral
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain.
| | - C Niño Rojo
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain
| | - R de la Fuente Olmos
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain
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De Muzio F, Fusco R, Cutolo C, Giacobbe G, Bruno F, Palumbo P, Danti G, Grazzini G, Flammia F, Borgheresi A, Agostini A, Grassi F, Giovagnoni A, Miele V, Barile A, Granata V. Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications. J Clin Med 2023; 12:1489. [PMID: 36836024 PMCID: PMC9966470 DOI: 10.3390/jcm12041489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/30/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Rectal cancer (RC) is one of the deadliest malignancies worldwide. Surgery is the most common treatment for RC, performed in 63.2% of patients. The type of surgical approach chosen aims to achieve maximum residual function with the lowest risk of recurrence. The selection is made by a multidisciplinary team that assesses the characteristics of the patient and the tumor. Total mesorectal excision (TME), including both low anterior resection (LAR) and abdominoperineal resection (APR), is still the standard of care for RC. Radical surgery is burdened by a 31% rate of major complications (Clavien-Dindo grade 3-4), such as anastomotic leaks and a risk of a permanent stoma. In recent years, less-invasive techniques, such as local excision, have been tested. These additional procedures could mitigate the morbidity of rectal resection, while providing acceptable oncologic results. The "watch and wait" approach is not a globally accepted model of care but encouraging results on selected groups of patients make it a promising strategy. In this plethora of treatments, the radiologist is called upon to distinguish a physiological from a pathological postoperative finding. The aim of this narrative review is to identify the main post-surgical complications and the most effective imaging techniques.
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Affiliation(s)
- Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | | | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Giulia Grazzini
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Federica Flammia
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122 Milan, Italy
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli”, 80131 Naples, Italy
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Haouari MA, Boulay-Coletta I, Khatri G, Touloupas C, Anglaret S, Tardivel AM, Beranger-Gibert S, Silvera S, Loriau J, Zins M. Complications of Mesh Sacrocolpopexy and Rectopexy: Imaging Review. Radiographics 2023; 43:e220137. [PMID: 36701247 DOI: 10.1148/rg.220137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sacrocolpopexy and rectopexy are commonly used surgical options for treatment of patients with pelvic organ and rectal prolapse, respectively. These procedures involve surgical fixation of the vaginal vault or the rectum to the sacral promontory with mesh material and can be performed independently of each other or in a combined fashion and by using an open abdominal approach or laparoscopy with or without robotic assistance. Radiologists can be particularly helpful in cases where patients' surgical histories are unclear by identifying normal sacrocolpopexy or rectopexy mesh material and any associated complications. Acute complications such as bleeding or urinary tract injury or stricture are generally evaluated with CT. More chronic complications such as mesh extrusion or exposure with or without fistulization to surrounding structures are generally evaluated with MRI. Other complications can have a variable time of onset after surgery. Patients with suspected bowel obstruction are generally evaluated with CT. Those with suspected infection, abscess formation, and discitis or osteomyelitis may be evaluated with MRI, although CT evaluation may be appropriate in certain scenarios. The authors review the sacrocolpopexy and rectopexy surgical techniques, discuss appropriate imaging protocols for evaluation of patients with suspected complications, and illustrate the normal appearance and common complications of these procedures. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mohamed Amine Haouari
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Isabelle Boulay-Coletta
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Gaurav Khatri
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Caroline Touloupas
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Sophie Anglaret
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Anne-Marie Tardivel
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Sophie Beranger-Gibert
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Stephane Silvera
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Jerome Loriau
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Marc Zins
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
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Diagnostic nomogram for closed-loop small bowel obstruction requiring emergency surgery. Am J Emerg Med 2023; 63:5-11. [PMID: 36283292 DOI: 10.1016/j.ajem.2022.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 12/07/2022] Open
Abstract
PURPOSE This study aimed to build a diagnostic model of closed-loop small bowel obstruction (CL-SBO) using clinical information, blood test results, and computed tomography (CT) findings. METHODS All patients who were diagnosed with small bowel obstruction (SBO) and underwent surgery between January 1, 2018, and October 31, 2021, in the affiliated hospital of Qingdao university were reviewed, and their relevant preoperative information was collected. All variables were selected using univariate analysis and backward stepwise regression to build a diagnostic nomogram model. K-fold cross-validation and bootstrap resampling techniques were used for internal validation, and data from Qingdao Central Hospital were used for external validation. We also evaluated the diagnostic performance of each CT finding and performed subgroup analysis according to bowel ischemia in the closed-loop small bowel obstruction (CL-SBO) group. RESULTS A total of 219 patients (95 in the CL-SBO group and 124 in the open-loop small bowel obstruction [OL-SBO] group) were included in our research. D-dimers (median 1085 vs. 690, P = 0.019), tenderness (77.9% vs. 59.7%, P = 0.004), more than one beak sign (65.3% vs. 30.6%, P < 0.001), radial distribution (18.9% vs. 6.5%, P = 0.005), whirl sign (35.8% vs. 8.9%, P < 0.001), and ascites (71.6% vs. 53.2%, P = 0.006) were selected as the predictive variables of the nomogram. This model's Harrell's C statistic was 0.786 (95% confidence interval (CI), 0.724-0.848), and the Brier score was 0.182. The Harrell's C statistic of external validation was 0.784 (95%CI, 0.664-0.905); the Brier score was 0.190. Regarding the CT findings, radial distribution, U/C-shaped loop, and whirl sign had high specificity (93.5%, 96.0%, and 91.1%, respectively), but low sensitivity (18.9%, 8.4%, and 35.8%, respectively). D-dimer levels and tenderness were also associated with bowel ischemia. CONCLUSION The nomogram accurately predicted CL-SBO in patients with SBO, and surgery should be considered when patients have a high risk for developing CL-SBO.
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The value of MSCT in evaluating the passability of bezoar by conservative treatment for bezoars-induced small bowel obstruction. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:236-243. [PMID: 36242605 DOI: 10.1007/s00261-022-03700-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To explore the multi-slice spiral computed tomography (MSCT) imaging characteristics of patients with bezoars-induced small bowel obstruction (BI-SBO) to evaluate the risk of conservative treatment. MATERIALS AND METHODS This retrospective study included 72 patients with BI-SBO who underwent whole-abdominal MSCT scan within 1 day before treatment. The patients were classified as the non-pass group and pass group depending on whether bezoar can pass after conservative treatment. The CT images were observed and measured by two radiologists. Statistical analysis was performed by using Student's t test, Pearson's chi-squared test, Fisher's exact test, Logistic linear regression, and receiver operating characteristic curve (ROC). RESULTS The study population consisted of 72 patients with a mean age of 52.2 ± 16.2 years (32 men and 40 women with an age range of 13-81 years). There were statistical differences between the two groups in the bezoar appearance, maximum HU of bezoar, thickness of intestinal wall, mesenteric haziness, mesenteric fluid, and peritoneal fluid (P = 0.002, 0.024, 0.017, 0.006, 0.021, and 0.030). The appearance of bezoar and mesenteric haziness is independent risk factors affecting whether bezoar can be passed by the conservative treatment. Sensitivity (41.7%) was decreased, NPV (76.3%) was not significantly changed, specificity (93.8%) and PPV (76.9%) were improved when both parameters were met to assess failure of conservative treatment. CONCLUSION The observation of important signs by MSCT and its reconstruction technology is of great clinical value in evaluating the passability of bezoar by conservative treatment, and which can provide radiographic basis for clinical treatment selection.
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Li Y, Tian Z, Liu C, Li S, Bi W, Ji Q. A Nomogram Prediction Model for Internal Hernia Using Clinical Parameters and Non-Enhanced Computed Tomography Imaging. J Gastrointest Surg 2022; 27:998-1000. [PMID: 36509895 PMCID: PMC10133087 DOI: 10.1007/s11605-022-05429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/16/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Yunlong Li
- Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Zhen Tian
- Department of Anorectal Center, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, China
| | - Chengcong Liu
- Department of Gastrointestinal Surgery, Qingdao Central Hospital, Qingdao, Shandong, China
| | - Shikuan Li
- Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China.
| | - Weiqun Bi
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qinglian Ji
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Chen B, Sheng WY, Ma BQ, Mei BS, Xiao T, Zhang JX. Progress in diagnosis and treatment of surgery-related adhesive small intestinal obstruction. Shijie Huaren Xiaohua Zazhi 2022; 30:1016-1023. [DOI: 10.11569/wcjd.v30.i23.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Adhesive small bowel obstruction is a relatively common surgical acute abdomen, which is caused by various factors that result in the contents of the small bowel failing to pass smoothly. The clinical symptoms include abdominal pain, distension, nausea and vomiting, and defecation disorder. The chance of adhesive small bowel obstruction to develop in patients with a history of abdominal surgery is around 2.4%. This paper discusses the most recent developments in the conservative and surgical management of adhesive small bowel obstruction based on clinical manifestation, laboratory analysis, and imaging examination.
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Affiliation(s)
- Biao Chen
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Wei-Yong Sheng
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Bing-Qing Ma
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Bo-Sheng Mei
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Tian Xiao
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Jin-Xiang Zhang
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Olausson M, Aerenlund MP, Azzam M, Bjerke T, Burcharth JFH, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Ngo-Stuyt L, Nielsen EØ, Nielsen LBJ, Skovsen AP, Tolver MA, Smith HG. Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study. Eur J Trauma Emerg Surg 2022; 49:1121-1130. [PMID: 36357790 PMCID: PMC9648885 DOI: 10.1007/s00068-022-02171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022]
Abstract
AIMS The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, a more surgically aggressive strategy has traditionally been used, but to what extent patient outcomes differ from international reports is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark. METHODS This was a prospective cohort study conducted at six acute hospitals in Denmark over a 4-month period. Patients aged ≥ 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30 day morbidity and mortality rates. RESULTS 316 patients were included during the study period. The median age was 72 years and 56% were female. Diagnosis was made by computed tomography (CT) in 313 patients (99.1%), with the remaining three diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 119 (78.3%). Urgent surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The entire cohort had a 30 day mortality rate of 7.3% and a 30 day morbidity rate of 17.1%. CONCLUSIONS The management of SBO in Denmark differs markedly to previous international reports, with an almost ubiquitous use of CT for diagnosis and a high proportion of patients undergoing urgent surgery. Despite higher rates of surgery, patient outcomes are broadly similar to reports of more conservative strategies, perhaps due to a reduction in delayed operations. TRIAL REGISTRATION Trial registration number: NCT04750811. Trial registration date: 11/02/2021.
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Affiliation(s)
- M Olausson
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - M P Aerenlund
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J F H Burcharth
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L B J Nielsen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - H G Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
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Obstrucción intestinal: signos de indicación quirúrgica urgente. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kobayashi T, Chiba N, Koganezawa I, Nakagawa M, Yokozuka K, Ochiai S, Gunji T, Sano T, Tomita K, Tabuchi S, Hidaka E, Kawachi S. Prediction model for irreversible intestinal ischemia in strangulated bowel obstruction. BMC Surg 2022; 22:321. [PMID: 35996141 PMCID: PMC9396879 DOI: 10.1186/s12893-022-01769-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Preoperatively diagnosing irreversible intestinal ischemia in patients with strangulated bowel obstruction is difficult. Therefore, this study aimed to establish a prediction model for irreversible intestinal ischemia in strangulated bowel obstruction. Methods We included 83 patients who underwent emergency surgery for strangulated bowel obstruction between January 2014 and March 2022. The predictors of irreversible intestinal ischemia in strangulated bowel obstruction were identified using logistic regression analysis, and a prediction model for irreversible intestinal ischemia in strangulated bowel obstruction was established using the regression coefficients. Receiver operating characteristic analysis and fivefold cross-validation was used to assess the model. Results The prediction model (range, 0–4) was established using a white blood cell count of ≥ 12,000/µL and the computed tomography value of peritoneal fluid that was ≥ 20 Hounsfield units. The areas of the receiver operating characteristic curve of the new prediction model were 0.814 and 0.807 after fivefold cross-validation. A score of ≥ 2 was strongly suggestive of irreversible intestinal ischemia in strangulated bowel obstruction and necessitated bowel resection (odds ratio = 15.938). The bowel resection rates for the prediction scores of 0, 2, and 4 were 15.2%, 66.7%, and 85.0%, respectively. Conclusion Our model may help predict irreversible intestinal ischemia that necessitates bowel resection for strangulated bowel obstruction cases and thus enable surgeons to recognize the severity of the situation, prepare for deterioration of patients with progression of intestinal ischemia, and select the appropriate surgical procedure for treatment.
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Affiliation(s)
- Toshimichi Kobayashi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Itsuki Koganezawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masashi Nakagawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kei Yokozuka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Shigeto Ochiai
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Satoshi Tabuchi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Eiji Hidaka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
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Hirao H, Okabe H, Masuda T, Ogawa D, Uemura N, Kuroda D, Taki K, Tomiyasu S, Hirota M, Hibi T, Baba H, Sugita H. Intestinal Fluid CT Level Could Predict Pathological Small Bowel Ischemia in Small Bowel Obstruction. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03437-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1980371. [PMID: 35935303 PMCID: PMC9325346 DOI: 10.1155/2022/1980371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
We aimed to analyze the computed tomography (CT) imaging signs of bowel wall ischemia in patients with acute intestinal obstruction and construct an imaging prediction model to guide clinical treatment. The CT imaging signs of patients with acute intestinal obstruction diagnosed in our center in recent 6 years were collected for retrospective analysis. The etiology of intestinal obstruction and incidence rate of bowel wall ischemia were recorded, and the specific CT findings of bowel wall ischemia, including mesenteric edema, bowel wall thickening, and fish tooth sign, were analyzed. Among the 302 patients selected, 130 surgically treated patients were eligible for analysis. Bowel wall ischemia in acute intestinal obstruction showed an incidence rate of 14.90%, and the incidence rates of bowel wall ischemia in intra-abdominal hernia, intussusception, incarcerated external abdominal hernia, and volvulus were about 92.30%, 50%, 35.71%, 33.33%, and 12.59%, respectively. The incidence rate of bowel wall ischemia in simple adhesive intestinal obstruction was about 12.59%, and that in malignancy-induced intestinal obstruction was about 6.56%. Univariate analysis revealed 5 factors with statistical significance, including bowel wall thickening, mesenteric edema, bowel wall pneumatosis, ascites, and fish tooth sign. Multivariate logistic regression analysis indicated that fish tooth sign, bowel wall thickening, and mesenteric edema were able to predict bowel wall ischemia, and the corresponding partial regression coefficients were 2.164, 1.129, and 1.173, odds ratios (ORs) were 8.707, 3.093, and 3.232, sensitivity was 0.356, 0.400, and 0.844, and specificity was 0.859, 0.835, and 0.529, respectively. Imaging signs of bowel wall thickening, mesenteric edema, and fish tooth sign are valuable in predicting bowel wall ischemia, among which bowel wall thickening and mesenteric edema have relatively high specificity and fish tooth sign has a relatively high sensitivity. Furthermore, a fish tooth sign has the most favorable predictive value for bowel wall ischemia in acute intestinal obstruction, followed by bowel wall thickening and mesenteric edema.
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Toneman MK, de Kok BM, Zijta FM, Oei S, van Acker GJD, Westerterp M, van der Pool AEM. Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics. World J Gastrointest Surg 2022; 14:556-566. [PMID: 35979424 PMCID: PMC9258239 DOI: 10.4240/wjgs.v14.i6.556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/24/2021] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Closed-loop small bowel obstruction (CL-SBO) can threaten the viability of the intestine by obstructing a bowel segment at two adjacent points. Prompt recognition and surgery are crucial.
AIM To analyze the outcomes of patients who underwent surgery for CL-SBO and to evaluate clinical predictors.
METHODS Patients who underwent surgery for suspected CL-BSO on computed tomography (CT) at a single center between 2013 and 2019 were evaluated retrospectively. Patients were divided into three groups by perioperative outcome, including viable bowel, reversible ischemia, and irreversible ischemia. Clinical and laboratorial variables at presentation were compared and postoperative outcomes were analyzed.
RESULTS Of 148 patients with CL-SBO, 28 (19%) had a perioperative viable small bowel, 86 (58%) had reversible ischemia, and 34 (23%) had irreversible ischemia. Patients with a higher age had higher risk for perioperative irreversible ischemia [odds ratio (OR): 1.03, 95% confidence interval (CI): 0.99-1.06]. Patients with American Society of Anaesthesiologists (ASA) classification ≥ 3 had higher risk of perioperative irreversible ischemia compared to lower ASA classifications (OR: 3.76, 95%CI: 1.31-10.81). Eighty-six patients (58%) did not have elevated C-reactive protein (> 10 mg/L), and between-group differences were insignificant. Postoperative in-hospital stay was significantly longer for patients with irreversible ischemia (median 8 d, P = 0.001) than for those with reversible ischemia (median 6 d) or a viable bowel (median 5 d). Postoperative morbidity was significantly higher in patients with perioperative irreversible ischemia (45%, P = 0.043) compared with reversible ischemia (20%) and viable bowel (4%).
CONCLUSION Older patients or those with higher ASA classification had an increased risk of irreversible ischemia in case of CL-SBO. After irreversible ischemia, postoperative morbidity was increased.
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Affiliation(s)
- Masja K Toneman
- Department of Surgery, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Bente M de Kok
- Department of Radiology, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Frank M Zijta
- Department of Radiology, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Stanley Oei
- Department of Radiology, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Gijs J D van Acker
- Department of Surgery, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
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Xu WX, Zhong QH, Cai Y, Zhan CH, Chen S, Wang H, Lin L, Geng YQ, Hou P, Chen XQ, Zhang JR. Prediction and management of strangulated bowel obstruction: a multi-dimensional model analysis. BMC Gastroenterol 2022; 22:304. [PMID: 35733109 PMCID: PMC9219133 DOI: 10.1186/s12876-022-02363-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distinguishing strangulated bowel obstruction (StBO) from simple bowel obstruction (SiBO) still poses a challenge for emergency surgeons. We aimed to construct a predictive model that could distinctly discriminate StBO from SiBO based on the degree of bowel ischemia. METHODS The patients diagnosed with intestinal obstruction were enrolled and divided into SiBO group and StBO group. Binary logistic regression was applied to identify independent risk factors, and then predictive models based on radiological and multi-dimensional models were constructed. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess the accuracy of the predicted models. Via stratification analysis, we validated the multi-dimensional model in the prediction of transmural necrosis both in the training set and validation set. RESULTS Of the 281 patients with SBO, 45 (16.0%) were found to have StBO, while 236(84.0%) with SiBO. The AUC of the radiological model was 0.706 (95%CI, 0.617-0.795). In the multivariate analysis, seven risk factors including pain duration ≤ 3 days (OR = 3.775), rebound tenderness (OR = 5.201), low-to-absent bowel sounds (OR = 5.006), low levels of potassium (OR = 3.696) and sodium (OR = 3.753), high levels of BUN (OR = 4.349), high radiological score (OR = 11.264) were identified. The AUC of the multi-dimensional model was 0.857(95%CI, 0.793-0.920). In the stratification analysis, the proportion of patients with transmural necrosis was significantly greater in the high-risk group (24%) than in the medium-risk group (3%). No transmural necrosis was found in the low-risk group. The AUC of the validation set was 0.910 (95%CI, 0.843-0.976). None of patients in the low-risk and medium-risk score group suffered with StBO. However, all patients with bowel ischemia (12%) and necrosis (24%) were resorted into high-risk score group. CONCLUSION The novel multi-dimensional model offers a useful tool for predicting StBO. Clinical management could be performed according to the multivariate score.
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Affiliation(s)
- Wei-Xuan Xu
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Qi-Hong Zhong
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Yong Cai
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Can-Hong Zhan
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Lin Lin
- Department of Radiology, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ying-Qian Geng
- Department of Radiology, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ping Hou
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China.,Immunotherapy Institute, Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Xian-Qiang Chen
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China. .,Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| | - Jun-Rong Zhang
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China. .,Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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Boyer S, Lombard C, Urbaneja A, Vogrig C, Regent D, Blum A, Teixeira PAG. CT in non-traumatic acute abdominal emergencies: Comparison of unenhanced acquisitions and single-energy iodine mapping for the characterization of bowel wall enhancement. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2022; 2:100010. [PMID: 39076837 PMCID: PMC11265197 DOI: 10.1016/j.redii.2022.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/21/2022] [Indexed: 07/31/2024]
Abstract
Objectives To evaluate the benefit of unenhanced CT and single energy iodine mapping (SIM) to conventional contrast-enhanced CT for bowel wall enhancement characterization in an acute abdomen setting. Methods CT images from 45 patients with a suspected acute abdomen who underwent abdominopelvic CT from April 2018 to June 2018 were analyzed retrospectively by two independent radiologists. These patients had been referred by emergency department physicians in a context of acute abdominal pain and had a confirmed etiological diagnosis. Three image sets were evaluated separately (portal phase images alone; portal phase images and unenhanced images, portal phase images, and single energy iodine maps). Diagnostic accuracy and confidence were assessed. Quantitative analysis of bowel wall enhancement was also performed. Results The number of correct diagnoses increased by 8% and 12% with unenhanced images and 6% and 13% with SIM for readers 1 and 2, respectively, compared to the portal phase only. There was an improvement in the confidence of the etiological diagnosis with the number of certain diagnoses increasing from 23% to 100%, which was statistically significant for reader 2 and of borderline significance for reader 1 (P = 0.002 and 0.052, respectively) when unenhanced phase and SIM were added. The inter-rater agreement improved when unenhanced and portal phase images were associated, compared to portal phase images alone (kappa = 0.652 [ICC=0.482-0.822] and 0.42 [ICC=0.241-0.607] respectively). Conclusion SIM and unenhanced images improve the reproducibility and the diagnostic confidence to diagnose ischemic and inflammatory/infectious bowel wall thickening compared to portal phase images alone. Summary sentence The analysis of unenhanced and SIM images in association with portal phase images improves the reproducibility and the radiologist's confidence in the etiological diagnosis of acute non-traumatic bowel wall thickening in adults.
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Affiliation(s)
- Sophie Boyer
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Charles Lombard
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Ayla Urbaneja
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Céline Vogrig
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Denis Regent
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Alain Blum
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
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Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY) 2022; 47:1660-1683. [PMID: 34191075 DOI: 10.1007/s00261-021-03188-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
Acute bowel ischemia is a condition with high mortality and requires rapid intervention to avoid catastrophic outcomes. Swift and accurate imaging diagnosis is essential because clinical findings are commonly nonspecific. Conventional contrast enhanced CT of the abdomen has been the imaging modality of choice to evaluate suspected acute bowel ischemia. However, subtlety of image findings and lack of non-contrast or arterial phase images can make correct diagnosis challenging. Dual-energy CT provides valuable information toward assessing bowel ischemia. Dual-energy CT exploits the differential X-ray attenuation at two different photon energy levels to characterize the composition of tissues and reveal the presence or absence of faint intravenous iodinated contrast to improve reader confidence in detecting subtle bowel wall enhancement. With the same underlying technique, virtual non-contrast images can help to show non-enhancing hyperdense hemorrhage of the bowel wall in intravenous contrast-enhanced scans without the need to acquire actual non-contrast scans. Dual-energy CT derived low photon energy (keV) virtual monoenergetic images emphasize iodine contrast and provide CT angiography-like images from portal venous phase scans to better evaluate abdominal arterial patency. In Summary, dual-energy CT aids diagnosing acute bowel ischemia in multiple ways, including improving visualization of the bowel wall and mesenteric vasculature, revealing intramural hemorrhage in contrast enhanced scans, or possibly reducing intravenous contrast dose.
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Vanderbecq Q, Ardon R, De Reviers A, Ruppli C, Dallongeville A, Boulay-Coletta I, D’Assignies G, Zins M. Adhesion-related small bowel obstruction: deep learning for automatic transition-zone detection by CT. Insights Imaging 2022; 13:13. [PMID: 35072813 PMCID: PMC8787000 DOI: 10.1186/s13244-021-01150-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background To train a machine-learning model to locate the transition zone (TZ) of adhesion-related small bowel obstruction (SBO) on CT scans. Materials and methods We used 562 CTs performed in 2005–2018 in 404 patients with adhesion-related SBO. Annotation of the TZs was performed by experienced radiologists and trained residents using bounding boxes. Preprocessing involved using a pretrained model to extract the abdominopelvic region. We modeled TZ localization as a binary classification problem by splitting the abdominopelvic region into 125 patches. We then trained a neural network model to classify each patch as containing or not containing a TZ. We coupled this with a trained probabilistic estimation of presence of a TZ in each patch. The models were first evaluated by computing the area under the receiver operating characteristics curve (AUROC). Then, to assess the clinical benefit, we measured the proportion of total abdominopelvic volume classified as containing a TZ for several different false-negative rates. Results The probability of containing a TZ was highest for the hypogastric region (56.9%). The coupled classification network and probability mapping produced an AUROC of 0.93. For a 15% proportion of volume classified as containing TZs, the probability of highlighted patches containing a TZ was 92%.
Conclusion Modeling TZ localization by coupling convolutional neural network classification and probabilistic localization estimation shows the way to a possible automatic TZ detection, a complex radiological task with a major clinical impact. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01150-y.
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Chai Y, Xing J, Lv P, Liang P, Xu H, Yue S, Gao J. Evaluation of ischemia and necrosis in adhesive small bowel obstruction based on CT signs: Subjective visual evaluation and objective measurement. Eur J Radiol 2021; 147:110115. [PMID: 34990890 DOI: 10.1016/j.ejrad.2021.110115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/23/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the diagnostic performance of CT signs for detecting bowel ischemia and necrosis in adhesive small bowel obstruction(SBO) with subjective and objective methods. MATERIALS AND METHODS 113 adhesive SBO patients were enrolled and divided into ischemic group (49 cases in necrotic group and 35 cases in reversible ischemic group) and non-ischemic group (29 cases) according to the operation results. Subjective visual assessment of CT signs associated with ischemia and necrosis was performed by two radiologists independently. Elevated unenhanced attenuation and enhancement value of involved bowel wall were objectively measured and compared by single factor analysis of variance. Cut-off value and diagnostic performance were evaluated by receiver operating characteristic curve (ROC). RESULTS Closed-loop mechanism, reduced bowel wall enhancement, and mesenteric edema were associated with bowel ischemia, with sensitivity of 81.0%, 65.5%, 75.0%, and specificity of 86.2%, 96.6%, 89.7%, respectively. Increased unenhanced bowel wall attenuation was a specific sign for necrosis with 100.0% specificity and 51.0% sensitivity. The sensitivity and specificity for ischemia were 86.0% and 91.9% with cut-off enhancement value lower than 33.5 HU. The sensitivity and specificity for necrosis were 58.2% and 100.0% with cut-off elevated unenhanced attenuation higher than 16.5 HU, 86.7% and 83.3% with cut-off enhancement value lower than 21.5 HU. CONCLUSION Reduced bowel wall enhancement and increased unenhanced bowel wall attenuation were good indicators of bowel ischemia and necrosis. The objective measurement of elevated unenhanced attenuation and enhancement value can predict bowel ischemia and necrosis more accurately.
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Affiliation(s)
- Yaru Chai
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jingjing Xing
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Peijie Lv
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Huanan Xu
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Songwei Yue
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
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Pallan A, Dedelaite M, Mirajkar N, Newman PA, Plowright J, Ashraf S. Postoperative complications of colorectal cancer. Clin Radiol 2021; 76:896-907. [PMID: 34281707 DOI: 10.1016/j.crad.2021.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
Colorectal cancer is the third most common cancer, and surgery is the most common treatment. Several surgical options are available, but each is associated with a range of potential complications. The timely and efficient identification of these complications is vital for effective clinical management of these patients in order to minimise their morbidity and mortality. This review aims to describe the range of commonly performed surgical treatments for colorectal surgery. In addition, frequent post-surgical complications are explored with investigative options explained and illustrated.
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Affiliation(s)
- A Pallan
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - M Dedelaite
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - N Mirajkar
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P A Newman
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - J Plowright
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - S Ashraf
- Department of Colorectal Surgery, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
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Correlation of CT findings with intra-operative outcome in closed-loop small bowel obstruction (CL-SBO). Eur J Radiol 2021; 142:109844. [PMID: 34252868 DOI: 10.1016/j.ejrad.2021.109844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To correlate CT-findings in patients with closed-loop small bowel obstruction (CL-SBO) with perioperative findings, to identify patients who require immediate surgical intervention. Secondary purpose was to substantiate the role of radiologists in predicting perioperative outcome. METHODS Data were retrospectively obtained from patients with surgically confirmed CL-SBO, between September 2013 and September 2019. Three radiologists reviewed CTs to assess defined CT features and predict patient outcome for bowel wall ischemia and necrosis using a likelihood score. Univariate statistical analyses were performed and diagnostic performance parameters and interobserver agreement were assessed for each feature. RESULTS Of 148 included patients, 28 (19%) intraoperatively had viable bowel and 120 (81%) had bowel wall ischemia or necrosis. Most CT characteristics, as well as the likelihood of ischemia and necrosis, found fair or moderate multirater agreement. Increased attenuation of bowel wall and mesenteric vessels on non-contrast-enhanced CT had a specificity for bowel ischemia or necrosis of 100% (sensitivity respectively 48% (p < 0.001) and 21% (p = 0.09)). Mesenteric edema had high sensitivity for ischemia or necrosis (90%), but specificity of only 26% (p < 0.001). For mesenteric fluid, sensitivity was 60% and specificity 57% (p = 0.004). Decreased enhancement of bowel wall in both arterial and PV-phase showed significant correlation, respectively a sensitivity of 58% and 42%, and specificity of 88% and 79% (both p < 0.001). Likelihood of both ischemia and necrosis were significantly correlated with perioperative outcome (p < 0.001). CONCLUSION CT findings concerning mesenteric and bowel wall changes, as well as radiologists' judgement of likelihood of ischemia and necrosis are significantly correlated with perioperative outcome of bowel wall ischemia and necrosis in patients with CL-SBO.
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Suzuki Y, Yamamoto M, Sugiyama K, Akai T, Suzuki K, Kawamura T, Sakata M, Morita Y, Kikuchi H, Hiramatsu Y, Kurachi K, Unno N, Takeuchi H. Usefulness of a finger-mounted tissue oximeter with near-infrared spectroscopy for evaluating the intestinal oxygenation and viability in rats. Surg Today 2021; 51:931-940. [PMID: 33108523 PMCID: PMC8141489 DOI: 10.1007/s00595-020-02171-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/26/2020] [Indexed: 12/04/2022]
Abstract
PURPOSE To investigate the utility of the device for evaluating intestinal oxygenation and viability using an animal model. METHODS Sprague-Dawley rats underwent laparotomy under general anesthesia, and the blood vessels in the terminal ileum were clamped to create ischemia. We measured the regional tissue oxygenation saturation (rSO2) using an oximeter after 1, 3, and 6 h of vessel clamping. Ischemic tissue damage was assessed using a histological score. The intestine was reperfused after each clamping period, and intestinal rSO2 and survival rate were evaluated. RESULTS When reperfusion was performed at 1 and 3 h after ischemia, rSO2 increased after 10 min, and it improved to the same level as for normal intestine after 1 h; all rats survived for 1 week. In contrast, after 6 h of ischemia, rSO2 did not increase after reperfusion, and all animals died within 2 days. The histological scores increased after 1 h of reperfusion, with longer clamping periods. CONCLUSION A finger-mounted tissue oximeter could evaluate intestinal ischemia and the viability, which is thus considered to be a promising result for future clinical application.
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Affiliation(s)
- Yuhi Suzuki
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Masayoshi Yamamoto
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kosuke Sugiyama
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshiya Akai
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Katsunori Suzuki
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Takafumi Kawamura
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Mayu Sakata
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshifumi Morita
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hirotoshi Kikuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshihiro Hiramatsu
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kiyotaka Kurachi
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Naoki Unno
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Vascular Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka, 432-8580, Japan
| | - Hiroya Takeuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
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Lebert P, Ernst O, Zins M, Lanchou M, Nzamushe JR, Vermersch M. Pneumatosis intestinalis and portal venous gas in mechanical small bowel obstruction: Is it worrisome? Diagn Interv Imaging 2021; 102:545-551. [PMID: 34030989 DOI: 10.1016/j.diii.2021.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) in patients with mechanical small bowel obstruction (SBO), using surgical findings or clinical follow-up as standard of reference. MATERIALS AND METHODS Fourteen patients with mechanical SBO associated with PI and PVG were retrospectively included. There were 7 men and 7 women with a mean age of 59±19 (SD) (range: 25-93 years). CT examinations were reviewed by two radiologists to confirm the diagnosis of mechanical SBO and make a description of PI. Interobserver agreement was calculated. The reference standard was intraoperative appearance of the bowel wall (10/14; 71%) or the recovery of a normal bowel function in patients who were managed conservatively (4/14; 29%). RESULTS Among the 10 patients who underwent surgery, a normal appearance of the bowel in association with PI on CT was found intraoperatively in 8/10 (80%) patients and a reversible ischemia in the remaining 2/10 (20%) patients. The four patients who were managed conservatively recovered normal bowel function. Two patients died within two weeks following SBO. CONCLUSION PI and PVG are not specific signs of bowel necrosis in mechanical SBO.
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Affiliation(s)
- Paul Lebert
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France.
| | - Olivier Ernst
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Marc Zins
- Department of Radiology, Fondation Hôpital Saint-Joseph, 75014 Paris, France
| | - Marie Lanchou
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Jean-Robert Nzamushe
- Department of Emergency Surgery, Lille University Hospital, 59037 Lille Cedex, France
| | - Mathilde Vermersch
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
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Davarpanah AH, Ghamari Khameneh A, Khosravi B, Mir A, Saffar H, Radmard AR. Many faces of acute bowel ischemia: overview of radiologic staging. Insights Imaging 2021; 12:56. [PMID: 33914188 PMCID: PMC8085211 DOI: 10.1186/s13244-021-00985-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Acute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient's management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.
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Affiliation(s)
- Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| | - Afshar Ghamari Khameneh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, 14117, North Kargar St., Tehran, Iran
| | - Ali Mir
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, 14117, North Kargar St., Tehran, Iran.
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Fitzpatrick LA, Rivers-Bowerman MD, Thipphavong S, Clarke SE, Rowe JA, Costa AF. Pearls, Pitfalls, and Conditions that Mimic Mesenteric Ischemia at CT. Radiographics 2021; 40:545-561. [PMID: 32125953 DOI: 10.1148/rg.2020190122] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate. The diagnosis of AMI is challenging because patient symptoms and laboratory test results are often nonspecific. A high degree of clinical and radiologic suspicion is required for accurate and timely diagnosis. CT angiography of the abdomen and pelvis is the first-line imaging test for suspected AMI and should be expedited. A systematic "inside-out" approach to interpreting CT angiographic images, beginning with the bowel lumen and proceeding outward to the bowel wall, mesentery, vasculature, and extraintestinal viscera, provides radiologists with a practical framework to improve detection and synthesis of imaging findings. The subtypes of AMI are arterial and venoocclusive disease, nonocclusive ischemia, and strangulating bowel obstruction; each may demonstrate specific imaging findings. Chronic mesenteric ischemia is more insidious at onset and almost always secondary to atherosclerosis. Potential pitfalls in the diagnosis of AMI include mistaking pneumatosis as a sign that is specific for AMI and not an imaging finding, misinterpretation of adynamic ileus as a benign finding, and pseudopneumatosis. Several enterocolitides can mimic AMI at CT angiography, such as inflammatory bowel disease, infections, angioedema, and radiation-induced enterocolitis. Awareness of pitfalls, conditions that mimic AMI, and potential distinguishing clinical and imaging features can assist radiologists in making an early and accurate diagnosis of AMI. ©RSNA, 2020.
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Affiliation(s)
- Laura A Fitzpatrick
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Michael D Rivers-Bowerman
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Seng Thipphavong
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Sharon E Clarke
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Judy A Rowe
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Andreu F Costa
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
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