Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Computed Tomography in Emergency Diagnosis and Management Considerations of Small Bowel Obstruction for Surgical vs. Non-surgical Approach

Author(s): Saeed Taghavifar, Peter Joyce, Sana Salehi*, Faisal Khosa, Heeseop Shin, Ali Gholamrezanezhad and Samad Shah

Volume 18, Issue 3, 2022

Published on: 10 January, 2022

Article ID: e280621194348 Pages: 10

DOI: 10.2174/1573405617666210628154218

Price: $65

Abstract

Background: Background: Small Bowel Obstruction (SBO) accounts for 15% of abdominal pain complaints referred to emergency departments and imposes significant financial burdens on the healthcare system. The most common symptom and sign of SBO is the absence of stool or flatus passsage and abdominal distension, respectively. Patients who do not demonstrate severe clinical or imaging findings are typically treated with conservative approaches. Patients with clinical signs of sepsis or physical findings of peritonitis are often instantly transferred to the operating room without supplementary imaging assessment. However, in cases where symptoms are non-specific or physical examination is challenging, such as in cases with loss of consciousness, the diagnosis can be complicated. This paper discusses the key findings identifiable on Computed Tomography (CT) which are vital for the emergent triage, proper treatment and appropriate decision making in patients with suspected SBO.

Methods: Narrative review of the literature.

Results: CT plays a key role in emergent triage, proper treatment and decision making and provides high sensitivity, specificity, and accuracy in the detection of early-stage obstruction and acute intestinal vascular compromise. CT can also differentiate between various etiologies of SBO entity which is considered an important criterion in the triage of patients into surgical vs. non-surgical treatment.

Conclusion: There Key CT findings which may suggest a need for surgical treatment include mesenteric edema, lack of the small-bowel feces, bowel wall thickening, fat stranding in the mesentery, and intraperitoneal fluid which are predictive of urgent surgical exploration.

Keywords: Abdominal pain, intestinal obstruction, emergency service, hospital, sepsis, tomography, X-Ray computed, radiology.

Graphical Abstract

[1]
Hastings RS, Powers RD. Abdominal pain in the ED: A 35 year retrospective. Am J Emerg Med 2011; 29(7): 711-6.
[http://dx.doi.org/10.1016/j.ajem.2010.01.045] [PMID: 20825873]
[2]
Jeppesen M, Tolstrup MB, Gögenur I. Chronic pain, quality of life, and functional impairment after surgery due to small bowel obstruction. World J Surg 2016; 40(9): 2091-7.
[http://dx.doi.org/10.1007/s00268-016-3616-9] [PMID: 27384171]
[3]
Loftus T, Moore F, VanZant E, et al. A protocol for the management of adhesive small bowel obstruction. J Trauma Acute Care Surg 2015; 78(1): 13-9.
[http://dx.doi.org/10.1097/TA.0000000000000491] [PMID: 25539198]
[4]
Deshmukh SD, Shin DS, Willmann JK, Rosenberg J, Shin L, Jeffrey RB. Non-emergency small bowel obstruction: Assessment of CT findings that predict need for surgery. Eur Radiol 2011; 21(5): 982-6.
[http://dx.doi.org/10.1007/s00330-010-1983-4] [PMID: 20963444]
[5]
Jones K, Mangram AJ, Lebron RA, Nadalo L, Dunn E. Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction? Am J Surg 2007; 194(6): 780-3.
[http://dx.doi.org/10.1016/j.amjsurg.2007.09.020] [PMID: 18005771]
[6]
Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: What to look for. Radiographics 2009; 29(2): 423-39.
[http://dx.doi.org/10.1148/rg.292085514] [PMID: 19325057]
[7]
Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV. Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR Am J Roentgenol 2000; 175(6): 1601-7.
[http://dx.doi.org/10.2214/ajr.175.6.1751601] [PMID: 11090385]
[8]
O’Malley RG, Al-Hawary MM, Kaza RK, Wasnik AP, Platt JF, Francis IR. MDCT findings in small bowel obstruction: Implications of the cause and presence of complications on treatment decisions. Abdom Imaging 2015; 40(7): 2248-62.
[http://dx.doi.org/10.1007/s00261-015-0477-x] [PMID: 26070748]
[9]
Rocha FG, Theman TA, Matros E, Ledbetter SM, Zinner MJ, Ferzoco SJ. Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography. Arch Surg 2009; 144(11): 1000-4.
[http://dx.doi.org/10.1001/archsurg.2009.183] [PMID: 19917935]
[10]
Sheedy SP, Earnest F IV, Fletcher JG, Fidler JL, Hoskin TL. CT of small-bowel ischemia associated with obstruction in emergency department patients: Diagnostic performance evaluation. Radiology 2006; 241(3): 729-36.
[http://dx.doi.org/10.1148/radiol.2413050965] [PMID: 17114622]
[11]
Wright HK, O’Brien JJ, Tilson MD. Water absorption in experimental closed segment obstruction of the ileum in man. Am J Surg 1971; 121(1): 96-9.
[http://dx.doi.org/10.1016/0002-9610(71)90083-3] [PMID: 5540839]
[12]
Markogiannakis H, Messaris E, Dardamanis D, et al. Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome. World J Gastroenterol 2007; 13(3): 432-7.
[http://dx.doi.org/10.3748/wjg.v13.i3.432] [PMID: 17230614]
[13]
Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: A narrative review for all physicians. World J Emerg Surg 2019; 14: 20.
[http://dx.doi.org/10.1186/s13017-019-0240-7] [PMID: 31168315]
[14]
Miller G, Boman J, Shrier I, Gordon PH. Etiology of small bowel obstruction. Am J Surg 2000; 180(1): 33-6.
[http://dx.doi.org/10.1016/S0002-9610(00)00407-4] [PMID: 11036136]
[15]
Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med 2013; 20(6): 528-44.
[http://dx.doi.org/10.1111/acem.12150] [PMID: 23758299]
[16]
Vrijland WW, Jeekel J, van Geldorp HJ, Swank DJ, Bonjer HJ. Abdominal adhesions: Intestinal obstruction, pain, and infertility. Surg Endosc 2003; 17(7): 1017-22.
[http://dx.doi.org/10.1007/s00464-002-9208-9] [PMID: 12632122]
[17]
Cheadle WG, Garr EE, Richardson JD. The importance of early diagnosis of small bowel obstruction. Am Surg 1988; 54(9): 565-9.
[PMID: 3415100]
[18]
Perea García J, Turégano Fuentes T, Quijada García B, et al. Adhesive small bowel obstruction: Predictive value of oral contrast administration on the need for surgery. Rev Esp Enferm Dig 2004; 96(3): 191-200.
[http://dx.doi.org/10.4321/S1130-01082004000300005] [PMID: 15053734]
[19]
Daneshmand S, Hedley CG, Stain SC. The utility and reliability of computed tomography scan in the diagnosis of small bowel obstruction. Am Surg 1999; 65(10): 922-6.
[PMID: 10515535]
[20]
Desser TS, Gross M. Multidetector row computed tomography of small bowel obstruction. Semin Ultrasound CT MR 2008; 29(5): 308-21.
[http://dx.doi.org/10.1053/j.sult.2008.06.004] [PMID: 18853838]
[21]
Furukawa A, Yamasaki M, Takahashi M, et al. CT diagnosis of small bowel obstruction: Scanning technique, interpretation and role in the diagnosis. Semin Ultrasound CT MR 2003; 24(5): 336-52.
[http://dx.doi.org/10.1016/j.sult.2003.08.001] [PMID: 14620716]
[22]
Maglinte DD, Reyes BL, Harmon BH, et al. Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol 1996; 167(6): 1451-5.
[http://dx.doi.org/10.2214/ajr.167.6.8956576] [PMID: 8956576]
[23]
Santillan CS. Computed tomography of small bowel obstruction. Radiol Clin North Am 2013; 51(1): 17-27.
[http://dx.doi.org/10.1016/j.rcl.2012.09.002] [PMID: 23182505]
[24]
Thompson WM, Kilani RK, Smith BB, et al. Accuracy of abdominal radiography in acute small-bowel obstruction: Does reviewer experience matter? AJR Am J Roentgenol 2007; 188(3): W233-8.
[http://dx.doi.org/10.2214/AJR.06.0817] [PMID: 17312028]
[25]
Jancelewicz T, Vu LT, Shawo AE, Yeh B, Gasper WJ, Harris HW. Predicting strangulated small bowel obstruction: An old problem revisited. J Gastrointest Surg 2009; 13(1): 93-9.
[http://dx.doi.org/10.1007/s11605-008-0610-z] [PMID: 18685902]
[26]
Becker BA, Lahham S, Gonzales MA, et al. A prospective, multicenter evaluation of point-of-care ultrasound for small-bowel obstruction in the emergency department. Acad Emerg Med 2019; 26(8): 921-30.
[http://dx.doi.org/10.1111/acem.13713] [PMID: 30762916]
[27]
Ten Broek RPG, Krielen P, Di Saverio S, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 2018; 13(1): 24.
[http://dx.doi.org/10.1186/s13017-018-0185-2] [PMID: 29946347]
[28]
Krause WR, Webb TP. Geriatric small bowel obstruction: An analysis of treatment and outcomes compared with a younger cohort. Am J Surg 2015; 209(2): 347-51.
[http://dx.doi.org/10.1016/j.amjsurg.2014.04.008] [PMID: 25048569]
[29]
Laurell H, Hansson L-E, Gunnarsson U. Acute abdominal pain among elderly patients. Gerontology 2006; 52(6): 339-44.
[http://dx.doi.org/10.1159/000094982] [PMID: 16905885]
[30]
Shih S-C, Jeng K-S, Lin S-C, et al. Adhesive small bowel obstruction: How long can patients tolerate conservative treatment? World J Gastroenterol 2003; 9(3): 603-5.
[http://dx.doi.org/10.3748/wjg.v9.i3.603] [PMID: 12632527]
[31]
Long B, Robertson J, Koyfman A. Emergency medicine evaluation and management of small bowel obstruction: Evidence-based recommendations. J Emerg Med 2019; 56(2): 166-76.
[http://dx.doi.org/10.1016/j.jemermed.2018.10.024] [PMID: 30527563]
[32]
Barnett RE, Younga J, Harris B, et al. Accuracy of computed tomography in small bowel obstruction. Am Surg 2013; 79(6): 641-3.
[http://dx.doi.org/10.1177/000313481307900628] [PMID: 23711277]
[33]
Di Saverio S, Coccolini F, Galati M, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 2013; 8(1): 42.
[http://dx.doi.org/10.1186/1749-7922-8-42] [PMID: 24112637]
[34]
Geffroy Y, Boulay-Coletta I, Jullès MC, Nakache S, Taourel P, Zins M. Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction. Radiology 2014; 270(1): 159-67.
[http://dx.doi.org/10.1148/radiol.13122654] [PMID: 24029649]
[35]
Hayakawa K, Tanikake M, Yoshida S, Yamamoto A, Yamamoto E, Morimoto T. CT findings of small bowel strangulation: The importance of contrast enhancement. Emerg Radiol 2013; 20(1): 3-9.
[http://dx.doi.org/10.1007/s10140-012-1070-z] [PMID: 22910982]
[36]
Duron VP, Rutigliano S, Machan JT, Dupuy DE, Mazzaglia PJ. Computed tomographic diagnosis of pneumatosis intestinalis: Clinical measures predictive of the need for surgical intervention. Arch Surg 2011; 146(5): 506-10.
[http://dx.doi.org/10.1001/archsurg.2011.95] [PMID: 21576602]
[37]
Paulson EK, Thompson WM. Review of small-bowel obstruction: The diagnosis and when to worry. Radiology 2015; 275(2): 332-42.
[http://dx.doi.org/10.1148/radiol.15131519] [PMID: 25906301]
[38]
Chang WC, Ko KH, Lin CS, et al. Features on MDCT that predict surgery in patients with adhesive-related small bowel obstruction. PLoS One 2014; 9(2): e89804.
[http://dx.doi.org/10.1371/journal.pone.0089804] [PMID: 24587047]
[39]
Millet I, Ruyer A, Alili C, et al. Adhesive small-bowel obstruction: Value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology 2014; 273(2): 425-32.
[http://dx.doi.org/10.1148/radiol.14132872] [PMID: 24991990]
[40]
Nakashima K, Ishimaru H, Fujimoto T, et al. Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction. Abdom Imaging 2015; 40(5): 1097-103.
[http://dx.doi.org/10.1007/s00261-014-0335-2] [PMID: 25542218]
[41]
Schein M, Assalia A. Small bowel obstruction-who needs an operation? World J Surg 2010; 34(5): 920-2.
[http://dx.doi.org/10.1007/s00268-010-0460-1] [PMID: 20217413]
[42]
Zielinski MD, Eiken PW, Heller SF, et al. Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg 2011; 212(6): 1068-76.
[http://dx.doi.org/10.1016/j.jamcollsurg.2011.02.023] [PMID: 21458305]
[43]
Jacobs SL, Rozenblit A, Ricci Z, et al. Small bowel faeces sign in patients without small bowel obstruction. Clin Radiol 2007; 62(4): 353-7.
[http://dx.doi.org/10.1016/j.crad.2006.11.007] [PMID: 17331829]
[44]
Colon MJ, Telem DA, Wong D, Divino CM. The relevance of transition zones on computed tomography in the management of small bowel obstruction. Surgery 2010; 147(3): 373-7.
[http://dx.doi.org/10.1016/j.surg.2009.10.005] [PMID: 20004431]
[45]
Suri RR, Vora P, Kirby JM, Ruo L. Computed tomography features associated with operative management for nonstrangulating small bowel obstruction. Can J Surg 2014; 57(4): 254-9.
[http://dx.doi.org/10.1503/cjs.008613] [PMID: 25078930]
[46]
Idris M, Kashif N, Idris S, Memon WA, Tanveer UH, Haider Z. Accuracy of 64-slice multidetector computed tomography scan in detection of the point of transition of small bowel obstruction. Jpn J Radiol 2012; 30(3): 235-41.
[http://dx.doi.org/10.1007/s11604-011-0038-3] [PMID: 22167345]
[47]
Hodel J, Zins M, Desmottes L, et al. Location of the transition zone in CT of small-bowel obstruction: Added value of multiplanar reformations. Abdom Imaging 2009; 34(1): 35-41.
[http://dx.doi.org/10.1007/s00261-007-9348-4] [PMID: 18172705]
[48]
Keoplung S, Teerasamit W, Suvannarerg V. Diagnosis of bowel obstruction: Added value of multiplanar reformations from multidetector CT in comparison with axial planes alone. J Med Assoc Thai 2013; 96(12): 1569-77.
[PMID: 24511722]
[49]
Atri M, McGregor C, McInnes M, et al. Multidetector helical CT in the evaluation of acute small bowel obstruction: Comparison of non-enhanced (no oral, rectal or IV contrast) and IV enhanced CT. Eur J Radiol 2009; 71(1): 135-40.
[http://dx.doi.org/10.1016/j.ejrad.2008.04.011] [PMID: 18534800]
[50]
Ohira G, Shuto K, Kono T, et al. Utility of arterial phase of dynamic CT for detection of intestinal ischemia associated with strangulation ileus. World J Radiol 2012; 4(11): 450-4.
[http://dx.doi.org/10.4329/wjr.v4.i11.450] [PMID: 23251723]
[51]
Taylor SA, Halligan S, Slater A, et al. Polyp detection with CT colonography: Primary 3D endoluminal analysis versus primary 2D transverse analysis with computer-assisted reader software. Radiology 2006; 239(3): 759-67.
[http://dx.doi.org/10.1148/radiol.2392050483] [PMID: 16543593]
[52]
Gottlieb M, Peksa GD, Pandurangadu AV, Nakitende D, Takhar S, Seethala RR. Utilization of ultrasound for the evaluation of small bowel obstruction: A systematic review and meta-analysis. Am J Emerg Med 2018; 36(2): 234-42.
[http://dx.doi.org/10.1016/j.ajem.2017.07.085] [PMID: 28797559]
[53]
Maglinte DD, Howard TJ, Lillemoe KD, Sandrasegaran K, Rex DK. Small-bowel obstruction: State-of-the-art imaging and its role in clinical management. Clin Gastroenterol Hepatol 2008; 6(2): 130-9.
[http://dx.doi.org/10.1016/j.cgh.2007.11.025] [PMID: 18187365]
[54]
Tamburrini S, Lugarà M, Iaselli F, et al. Diagnostic accuracy of ultrasound in the diagnosis of small bowel obstruction. Diagnostics (Basel) 2019; 9(3): E88.
[http://dx.doi.org/10.3390/diagnostics9030088] [PMID: 31390727]
[55]
Bugliosi TF, Meloy TD, Vukov LF. Acute abdominal pain in the elderly. Ann Emerg Med 1990; 19(12): 1383-6.
[http://dx.doi.org/10.1016/S0196-0644(05)82602-2] [PMID: 2240749]
[56]
Spangler R, Van Pham T, Khoujah D, Martinez JP. Abdominal emergencies in the geriatric patient. Int J Emerg Med 2014; 7: 43.
[http://dx.doi.org/10.1186/s12245-014-0043-2] [PMID: 25635203]
[57]
Arenal JJ, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 2003; 46(2): 111-6.
[PMID: 12691347]
[58]
Davis P, Hayden J, Springer J, Bailey J, Molinari M, Johnson P. Prognostic factors for morbidity and mortality in elderly patients undergoing acute gastrointestinal surgery: A systematic review. Can J Surg 2014; 57(2): E44-52.
[PMID: 24666459]
[59]
Scott JW, Olufajo OA, Brat GA, et al. Use of national burden to define operative emergency general surgery. JAMA Surg 2016; 151(6): e160480.
[http://dx.doi.org/10.1001/jamasurg.2016.0480] [PMID: 27120712]
[60]
Tolstrup MB, Watt SK, Gögenur I. Morbidity and mortality rates after emergency abdominal surgery: An analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy. Langenbecks Arch Surg 2017; 402(4): 615-23.
[http://dx.doi.org/10.1007/s00423-016-1493-1] [PMID: 27502400]
[61]
Aminzadeh F, Dalziel WB. Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 2002; 39(3): 238-47.
[http://dx.doi.org/10.1067/mem.2002.121523] [PMID: 11867975]
[62]
Ong M, Guang TY, Yang TK. Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience. World J Gastrointest Surg 2015; 7(9): 208-13.
[http://dx.doi.org/10.4240/wjgs.v7.i9.208] [PMID: 26425270]
[63]
Song W, Zhang T, Pu J, Shen L, He B. Incidence and risk of developing contrast-induced acute kidney injury following intravascular contrast administration in elderly patients. Clin Interv Aging 2014; 9: 85-93.
[PMID: 24403826]
[64]
Millet I, Alili C, Bouic-Pages E, Curros-Doyon F, Nagot N, Taourel P. Journal club: Acute abdominal pain in elderly patients: Effect of radiologist awareness of clinicobiologic information on CT accuracy. AJR Am J Roentgenol 2013; 201(6): 1171-8.
[http://dx.doi.org/10.2214/AJR.12.10287] [PMID: 24261352]
[65]
Reginelli A, Russo A, Pinto A, et al. The role of computed tomography in the preoperative assessment of gastrointestinal causes of acute abdomen in elderly patients. Int J Surg 2014; 12(Suppl. 2): S181-6.
[http://dx.doi.org/10.1016/j.ijsu.2014.08.345] [PMID: 25157993]
[66]
Millet I, Sebbane M, Molinari N, et al. Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management. Eur Radiol 2017; 27(2): 868-77.
[http://dx.doi.org/10.1007/s00330-016-4425-0] [PMID: 27271919]
[67]
Rubenstein LZ, Stuck AE, Siu AL, Wieland D. Impacts of geriatric evaluation and management programs on defined outcomes: Overview of the evidence. J Am Geriatr Soc 1991; 39(9 Pt 2): 8S-16S.
[http://dx.doi.org/10.1111/j.1532-5415.1991.tb05927.x] [PMID: 1832179]
[68]
Ozturk E, van Iersel M, Stommel MM, Schoon Y, Ten Broek RR, van Goor H. Small bowel obstruction in the elderly: A plea for comprehensive acute geriatric care. World J Emerg Surg 2018; 13: 48.
[http://dx.doi.org/10.1186/s13017-018-0208-z] [PMID: 30377439]
[69]
Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am 2008; 92(3): 575-97.
[http://dx.doi.org/10.1016/j.mcna.2008.01.003] [PMID: 18387377]
[70]
Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg 2010; 97(4): 470-8.
[http://dx.doi.org/10.1002/bjs.7019] [PMID: 20205228]
[71]
Ceresoli M, Coccolini F, Catena F, et al. Water-soluble contrast agent in adhesive small bowel obstruction: A systematic review and meta-analysis of diagnostic and therapeutic value. Am J Surg 2016; 211(6): 1114-25.
[http://dx.doi.org/10.1016/j.amjsurg.2015.06.012] [PMID: 26329902]
[72]
Koh A, Adiamah A, Chowdhury A, Mohiuddin MK, Bharathan B. Therapeutic role of water-soluble contrast media in adhesive small bowel obstruction: A systematic review and meta-analysis. J Gastrointest Surg 2020; 20(2): 473-83.
[PMID: 31485900]
[73]
Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg 1983; 145(1): 176-82.
[http://dx.doi.org/10.1016/0002-9610(83)90186-1] [PMID: 6849489]
[74]
Bickell NA, Federman AD, Aufses AH Jr. Influence of time on risk of bowel resection in complete small bowel obstruction. J Am Coll Surg 2005; 201(6): 847-54.
[http://dx.doi.org/10.1016/j.jamcollsurg.2005.07.005] [PMID: 16310687]
[75]
Parker MC, Ellis H, Moran BJ, et al. Postoperative adhesions: Ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum 2001; 44(6): 822-9.
[http://dx.doi.org/10.1007/BF02234701] [PMID: 11391142]
[76]
Parker MC, Wilson MS, van Goor H, et al. Adhesions and colorectal surgery - call for action. Colorectal Dis 2007; 9(Suppl. 2): 66-72.
[http://dx.doi.org/10.1111/j.1463-1318.2007.01342.x] [PMID: 17824973]
[77]
Frager D, Baer JW, Medwid SW, Rothpearl A, Bossart P. Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: Efficacy of CT. AJR Am J Roentgenol 1996; 166(1): 67-71.
[http://dx.doi.org/10.2214/ajr.166.1.8571907] [PMID: 8571907]
[78]
Ha HK, Kim JS, Lee MS, et al. Differentiation of simple and strangulated small-bowel obstructions: Usefulness of known CT criteria. Radiology 1997; 204(2): 507-12.
[http://dx.doi.org/10.1148/radiology.204.2.9240545] [PMID: 9240545]
[79]
Schwenter F, Poletti PA, Platon A, Perneger T, Morel P, Gervaz P. Clinicoradiological score for predicting the risk of strangulated small bowel obstruction. Br J Surg 2010; 97(7): 1119-25.
[http://dx.doi.org/10.1002/bjs.7037] [PMID: 20632281]

Rights & Permissions Print Cite
Article Metrics
44
1
© 2024 Bentham Science Publishers | Privacy Policy