Sensitivity and Specificity of CT and its Signs for Diagnosis of Strangulation in Patients with Acute Small Bowel Obstruction
DOI:
https://doi.org/10.31729/jnma.2148Abstract
Introduction: To perform a meta-analysis to review the sensitivity and specificity of computed tomography and different known CT signs for the diagnosis of strangulation in patients with acute SBO.
Methods:Â Pubmed search was performed for all reports that evaluated the use of CT and discussed different CT criteria for the diagnosis of acute SBO. Only articles published in English language between January 1978 to June 2008 were included. The bivariate random effect model was used to obtain pooled sensitivity and pooled specificity. Summary receiver operating curve was calculated using Meta-Disc. Software Openbugs 3.0.3 was used to summarize the data.
Results: A total of 12 studies fulfilled the inclusion criteria. The pooled sensitivity and specificity of CT in the diagnosis of strangulation was 0.720 (95% CI 0.674 to 0.763) and 0.866 (95% CI 0.837 to 0.892) respectively. The ranges to pooled sensivity and pooled specificity of different CT signs are 0.309 - 0.623 and 0.717 - 0.991 respectively.
Conclusions: This review demonstrates that the sensitivity and specificity of CT is high in preoperative diagnosis of strangulation in the setting of acute SBO which are in accordance with the published studies. Our analysis shows that “presence of mesenteric fluid†is the more sensitive, and “lack of bowel wall enhancement†is the more specific CT sign of strangulation, and also justifies need of large scale prospective studies to validate the results obtained as well as to determine a clinical protocol.
References
1) Mallo RD, Salem L, Lalani T, Flum DR. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg. 2005;9(5): 690–4.
2) Silen W, Hein M, Goldman L. Strangulation obstruction of the small intestine. Arch Surg 1962; 85: 121–9.
3) Leffall LD, Syphax B. Clinical aids in strangulation intestinal obstruction. Am J Surg, 1970; 120(6): 756–9.
4) Kim JH, Ha HK, Kim JK, Eun HW, Park KB, Kim BS, Kim TK, Kim JC, Auh YH. Usefulness of known computed tomography and clinical criteria for diagnosing strangulation in small-bowel obstruction: analysis of true and false interpretation groups in computed tomography. World J Surg. 2004; 28(1): 63–8.
5) Ha HK, Kim JS, Lee MS, Lee HJ, Jeong YK, Kim PN, Lee MG, Kim KW, Kim MY, Auh YH. Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria. Radiology. 1997;204(2): 507–12.
6) Donckier V, Closset J, Van Gansbeke D, Zalcman M, Sy M, Houben JJ, Lambilliotte JP. Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction. Br J Surg. 1998;85(8):1071–4.
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.
8) Sheedy SP, Earnest F 4th , 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.
9) Balthazar EJ, Liebeskind ME, Macari M. Intestinal ischaemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations and clinical implications of CT in diagnosis. Radiology 1997, 205(2): 519-22.
10) Balthazar EJ, Birnbaum BA, Megibow AJ, Gordon RB, Whelan CA, Hulnick DH. Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 1992; 185(3): 769–75.
11) Balthazar EJ. CT of small-bowel obstruction. AJR Am J Roentgenol. 1994;162(2): 255–61.
12) Taourel PG, Deneuville M, Pradel JA, Regent D, Bruel JM. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 1996,199(3): 632–6.
13) 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.
14) Ha HK, Park CH, Kim SK, Chun CS, Kim IC, Lee HK, Shinn KS, Bahk YW. CT analysis of intestinal obstruction due to adhesions: early detection of strangulation. J Comput Assist Tomogr 1993,17(3): 386–9.
15) Zalcman M, Van Gansbeke D, Lalmand B, Braudé P, Closset J, Struyven J Delayed enhancement of the bowel wall: a new CT sign of small bowel strangulation. J Comput Assist Tomogr 1996,20(3): 379–381.
16) Alpern MB, Glazer GM, Francis IR. Ischemic or infarcted bowel: CT findings. Radiology 1988,166(1 pt 1): 149–52.
17) Fisher JK Computed tomographic diagnosis of volvulus in intestinal malrotation. Radiology 1981,140(1): 145–6.
18) Jaramillo D, Raval B. CT diagnosis of primary small bowel volvulus. AJR Am J Roentgenol 1986,147(5): 941–2.
19) Jaeschke R, Guyatt G, Sackett DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1994, 271(5): 389-91.
20) Jaeschke R, Guyatt G, Sackett DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994, 271(9): 703-7.
21) Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003, 3: 25.
22) Yen CH, Chen JD, Tui CM, Chou YH, Lee CH, Chang CY, Yu C. Internal hernia: computed tomography diagnosis and differentiation from adhesive small bowel obstruction. J Chin Med Assoc. 2005, 68(1): 21-8.
23) Catel L, Lefevre F, Lauren V, canard L, Bresler L, Guillemin F, Regent D. small bowel obstruction from adhesions: which CT severity criteria to research? J Radiol. 2003, 84(1): 27-31.
24) Taourel PG, Fabre JM, Pradel JA, Seneterre EJ, Megibow AJ, Bruel JM. Value of CT in the diagnosis and management of patients with suspected acute small bowel obstruction. Am J Roentgenol. 1995, 165(5): 1187-92.
25) Evers BM. Small bowel. In: Townsend Cea, ed. Sabiston Textbook of Surgery. 16th ed. Philadelphia: W.B. Saunders Company; 2001: pp 883–88.
26) Bass KN, Jones B, Bulkley GB. Current management of small-bowel obstruction. Adv Surg. 1997, 31: 1–34.
27) Fevang BT, Jensen D, Svanes K, Viste A. Early operation or conservative management of patients with small bowel obstruction? Eur J Surg 2002, 168(8-9): 475–81.
28) Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K,Viste A. Complications and death after surgical treatment of small bowel obstruction: a 35-year institutional experience.Ann Surg. 2000, 231(4): 529–37.
29) Cheadle WG, Garr EE, Richardson JD. The importance of early diagnosis of small bowel obstruction. Am Surg. 1988, 54(9): 565–9.
30) Gough IR. Strangulating adhesive small bowel obstruction with normal radiographs. Br J Surg. 1978, 65(6): 431–4.
31) Sutherland F, Cunningham H, Pontikes L, Parsons L, Klassen J. Elevated serum interleukin 6 levels in patients with acute intestinal ischemia. Hepatogastroenterology. 2003, 50(50): 419–21.
32) Firoozmand E, Fairman N, Sklar J, Waxman K. Intravenous interleukin-6 levels predict need for laparotomy in patients with bowel obstruction. Am Surg. 2001, 67(12): 1145–9.
33) Irwig L, Macaskill P, Glasziou P, Fahey M. Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol. 1995, 48(1): 119-30.
34) Begg CB, McNeil BJ. Assessment of radiologic tests: control of bias and other design considerations. Radiology. 1988, 167(2): 565-9.
Downloads
Published
How to Cite
Issue
Section
License
JNMA allow to read, download, copy, distribute, print, search, or link to the full texts of its articles and allow readers to use them for any other lawful purpose. The author(s) are allowed to retain publishing rights without restrictions. The JNMA work is licensed under a Creative Commons Attribution 4.0 International License. More about Copyright Policy.
