Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process
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SPECIAL SECTION: INTESTINAL ISCHEMIA
Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process Mariano Scaglione1,2 · Michele Galluzzo3 · Domiziana Santucci4 · Margherita Trinci3 · Laura Messina4 · Ettore Laccetti1 · Eliodoro Faiella4 · Bruno Beomonte Zobel4 Received: 30 July 2020 / Revised: 21 September 2020 / Accepted: 29 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The objective of this article is to assess the computed tomography (CT) findings of small bowel obstruction (SBO) complicated by ischemia. SBO is a frequent clinical entity characterized by high morbidity and mortality. The radiologic aim is not just to diagnose the obstruction itself but to rule out the presence of complications related to SBO. This is crucial for differentiating which patients can be safely treated non-operatively from the ones who may need an urgent surgical approach. The main complication of SBO is intestinal ischemia. In the emergency setting, CT imaging is the modality of choice for SBO because of its ability to assess the bowel wall, the supporting mesentery and peritoneal cavity all in one. On the other hand, the radiologist who documents an intestinal ischemia should think about SBO as possible cause. In this case, the main finding which helps the radiologist in the identification of SBO is the presence of multiple and packed valvulae conniventes in the dilated bowel wall and the “transition zone” that indicates the passage between compressed and decompressed small bowel, otherwise the localization of the obstruction cause. Once the site of obstruction has been recognized, the other issue is to assess the cause of obstruction, considering that the most common cause of SBO remains “unidentified” and related to intra-abdominal adhesions. After that, the following most important point is to rule out the presence of an ischemic bowel and mesenteric changes associated to SBO. CT signs of bowel ischemia include reduced or increased bowel wall enhancement, mesenteric edema or engorgement, fluid or free air in the peritoneal cavity. This condition usually leads to an urgent laparotomy and, in some cases, to a surgical resection. Keywords Small bowel obstruction (SBO) · Computed tomography (CT) · Closed-loop obstruction · Small bowel ischemia
Introduction Small bowel obstruction (SBO) is a frequent clinical entity responsible for 12 to 16% of all emergency surgical admissions for patients with an acute abdomen for a total of about * Domiziana Santucci [email protected] 1
Department of Radiology, Pineta Grande Hospital, Via Domitiana KM 30, 81030 Castel Volturno, Italy
2
Teeside University & Department of Radiology, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK
3
Department of Radiology, “San Camillo Forlannini” Hospital, Circonvallazione Gianicolense, 87, 00100 Rome, Italy
4
Department of Radiology, University of Rome “Campus Bio-medico”, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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