Accéder directement au contenu Accéder directement à la navigation
Article dans une revue

CT diagnosis of closed loop bowel obstruction mechanism is not sufficient to indicate emergent surgery

Abstract : To identify computed tomography (CT) findings associated with successful conservative treatment of closed loop small bowel obstruction (CL-SBO) due to adhesions or internal herniation. Material and methods: The local institutional review board approved this study while waiving informed consent. Clinical and CT data were collected retrospectively for 96 consecutive patients with a CT diagnosis of CL-SBO due to adhesions or internal herniation established by experienced radiologists who had no role in patient management. Mechanical obstruction with at least two transition zones on the bowel at a single site defined CL-SBO. Two radiologists blinded to patient data independently performed a retrospective review of the CT scans. The patient groups with successful versus failed initial conservative therapy were compared. Univariate and multivariate analyses were performed to look for CT findings associated with successful conservative therapy. Interobserver agreement was assessed for each CT finding. Results: Of the 96 patients, 34 (35%) underwent immediate surgery and 62 (65%) received first-line conservative treatment, which succeeded in 19 (31%) and failed in 43 (69%). The distance between the transition zones was the only independent predictor of successful conservative therapy (odds ratio, 4.6 when ≥ 8 mm; 95% confidence interval [95% CI], 1.2-18.3). A distance ≥ 8 mm had 84% (95% CI, 60-97) sensitivity and 46% (95% CI, 31-62) specificity for successful conservative treatment. The correlation coefficient for the distance between transition zones between readers 1 and 2 was fair (r = 0.46). Conclusion: CL-SBO can be resolved without surgery. When there is no CT sign of ischemia, the distance between the transition zones should be assessed.
Liste complète des métadonnées

https://hal.umontpellier.fr/hal-03366574
Contributeur : Nathalie Salvy-Córdoba Connectez-vous pour contacter le contributeur
Soumis le : mardi 5 octobre 2021 - 17:08:38
Dernière modification le : mardi 22 mars 2022 - 22:52:02

Identifiants

Collections

Citation

Camille Rondenet, Ingrid Millet, Lucie Corno, Wassef Khaled, Isabelle Boulay-Coletta, et al.. CT diagnosis of closed loop bowel obstruction mechanism is not sufficient to indicate emergent surgery. European Radiology, Springer Verlag, 2020, 30 (2), pp.1105-1112. ⟨10.1007/s00330-019-06413-3⟩. ⟨hal-03366574⟩

Partager

Métriques

Consultations de la notice

23