CT Examination And Diagnosis Of Intestinal Obstruction

OBJECTIVE: 1. To discuss the CT manifestations of intestinal obstruction (IO), and evaluate the role of CT in the diagnosis and management of the patients suspected of IO. 2. To investigate the role of various CT detection techniques and steps in diagnosing IO, and optimize the roadmap of the CT examination for all kinds of IO.MATERIALS AND METHODS: Data of 297 cases were collected, of which, 280 cases were clinically or roentgenologically suspected of IO and 17 cases were clinically suspected of other diseases but were finally diagnosed as IO by CT. Preparations before CT examination, CT detection techniques (including plain, contrast-enhanced CT, delayed and/or dynamic scanning and images post-processing techniques), CT manifestations and diagnostic results were analyzed retrospectively, and compared with the results of surgical findings or clinical follow-up.RESULTS: 1. As to the presence diagnosis of IO, in all the patients, CT diagnosis was consistent with the final results, while X-ray plain film had an accuracy of only 48.9%(137/280). The causes of IO included adhesion(77.50%, 93/120), neoplasm (95.88%, 93/97), external or internal hernia (91.67%, 22/24), inflammatory disease (including 7 cases paralytic ileus, 85.00%, 17/20), bowel torsion (94.12%, 16/17), enterolith (100%, 9/9), intussusception (100%,5/5), ischemia(100%,5/5), trauma(80.00%,4/5), congenital lesion(100%,l/l). Total sensitivity of etiology diagnosis with CT was 89.23% (265/297), with accuracy, false positive and false negative to be 87.46% (265/303), 2.02%(6/297) and 10.77%(32/297), respectively. Whereas, accuracy before CT examination was only 21.55% (64/297). Of the 285 cases with mechanical intestinal obstruction, the accuracies, as to the position, degree, and presence of close-loop and strangulation, were 98.03% (149/152), 99.65% (284/285), 100.00% (285/285) and 90.48%(38/42), respectively. 2. Exacerbation or other severe complications caused by CT examination was not noted in our study.CONCLUSION: 1. CT can correctly diagnose the presence of the ileus, as well as its causes andcharacteristics,suchasposition,degreeofseverity,existenceofclose-loopand strangulation.2. Proper classification and preparation before CT exam are the basis of correct diagnosis. 3. CT plain scan, contrast-enhanced CT, delayed and/or dynamic scanning have different value of diagnosis, respectively. 4. Post-processing techniques is the necessary supplement of the forementioned methods and steps, which can reveal the lesion directly and reduce misdiagnosis.