Ces radiol. 2010, 64(4):269-275

Diagnostics of the acute bowel obstruction - plain X-ray, follow-through or MDCT?Original article

Jan Baxa¹, Jiří Ferda¹, Hynek Mírka¹, Jiří Moláček², Petr Novák², Vladislav Třeška², Boris Kreuzberg¹

¹ Klinika zobrazovacích metod, LF UK a FN, Plzeň

² Chirurgická klinika, LF UK a FN, Plzeň

Aim: Aim of our retrospective study was to evaluate diagnostic management of bowel obstruction and to compare it with contemporary literature.

Material and methods: We assess retrospectively the diagnostic procedure in patients hospitalized due to the suspected bowel obstruction in period 2006-2009. Our set of contains 374 patients (51,2% female, average age 65 years, age interval 19-90 years) and children till 18 years and persons in early post-operative period (3 weeks) were excluded. The following findings were checked: plain abdominal radiography (x-ray), bowel follow-through with water-soluble contrast agent (BFT) and multidetector computed tomography (MDCT); results were compared each other and with results of endoscopy and/or laparotomy.

Results: 95,7% of patients underwent plain x-ray (sensitivity 80,6%, specificity 49,5%, NPV 66,7% a PPV 78,6%). The BFT was performed in 39,8% of patients, 47,6% findings were positive according to the small bowel obstruction, in 33,6% were negative respectively (7 negative confirmed during laparotomy, NPV - 89%). 69% patients with obstruction underwent surgery and 31% were treated by conservative way. MDCT without endoluminal preparation was performed in 125 patients (33,4%), in 115 cases was found cause of obstruction. 72 patients underwent surgery and MDCT findings were confirmed in 100%. The increasing trend in MDCT indications was found.

Conclusion: Plain X-ray is most often used first imaging modality in patients with suspected bowel obstruction with good possibility to triage following patient's examinations and treatment. MDCT is best method to identify cause of obstruction. Bowel follow-through could be helpful in patients with "low-grade" obstruction.

Keywords: bowel obstruction, MDCT, plain X-ray, follow-through

Grants and funding:

Práce byla podpořena výzkumným projektem MSM 0021620819.

Accepted: November 1, 2010; Published: December 1, 2010  Show citation