RESUMO
PURPOSE: Small bowel obstruction (SBO) is a common cause of emergency presentations for abdominal pain and can be complicated by mesenteric ischemia. Computed tomography is currently central to diagnosis and management planning. Currently accepted signs identify secondary effects of the root physiological insult, which is vascular obstruction. We hypothesized that with advancements in CT technology and reconstruction algorithms, we can now more closely interrogate the mesenteric vasculature for obstruction and more accurately predict the need for surgical intervention. METHODS: We retrospectively audited the charts of all patients presenting with a clinical diagnosis of SBO at a single institution in a 12-month period. Two blinded consultant radiologists were then asked to analyze 3D MIP reconstruction CT scans for vascular obstruction in addition to any currently accepted signs of ischemia. Comparison between vascular cutoff and accepted current signs in the need for surgical intervention and the presence of any signs of ischemia in theater were recorded. RESULTS: Vascular cutoff had a comparable, with a trend towards superiority, sensitivity and specificity and inter-observer agreement to currently accepted signs of ischemia. The absence of a cut off sign has an excellent negative predictive value for ischemia with only 2 (3.7%) patients demonstrating ischemia at surgery where the vascular cutoff sign was not seen to be present. CONCLUSION: Interrogating vascular obstruction using 3D MIP reconstructions in small bowel obstruction may be a more sensitive and specific sign for prediction of surgical intervention, possibly occurring earlier in the obstruction pathway.
Assuntos
Obstrução Intestinal , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XAssuntos
Apendicectomia/efeitos adversos , Doenças do Ceco/patologia , Volvo Intestinal/etiologia , Doenças do Ceco/cirurgia , Cesárea/métodos , Feminino , Humanos , Recém-Nascido , Volvo Intestinal/cirurgia , Cuidados Intraoperatórios , Cetose/diagnóstico , Cetose/etiologia , Laparotomia/métodos , Masculino , Gravidez , Resultado do Tratamento , Adulto JovemRESUMO
Adjustable gastric banding (AGB) was a previously popular bariatric procedure, but adverse events such as erosion have surfaced as common complications. We present an interesting case of an AGB causing biliary obstruction after eroding into the stomach.
