scholarly journals CT scan findings do not predict outcome of nonoperative management in small bowel obstruction: Retrospective analysis of 108 consecutive patients

2016 ◽  
Vol 27 ◽  
pp. 88-91 ◽  
Author(s):  
Victor E. Pricolo ◽  
Filomena Curley
Keyword(s):  
Small Bowel ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Retrospective Analysis ◽  
Bowel Obstruction ◽  
Nonoperative Management

scholarly journals A wolf in sheep’s clothing: concomitant appendicitis with occult cecal adenocarcinoma

2021 ◽  
Vol 8 (7) ◽  
pp. 2154
Author(s):  
Jonathan Mejia ◽  
Roland Haj ◽  
Sutasinee Nithisoontorn ◽  
Martine A. Louis ◽  
Nageswara Mandava
Keyword(s):  
Differential Diagnosis ◽  
Small Bowel ◽  
Acute Appendicitis ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Delayed Presentation ◽  
Ct Guided ◽  
Distal Small Bowel ◽  
Risk Of Cancer

We present the case of an 89-years-old female with an atypical presentation of an obstructive acute appendicitis secondary to a cecal carcinoma. The physical exam revealed a distended abdomen with bilateral lower quadrants tenderness without rebound or rigidity.  CT scan demonstrated distal small bowel obstruction and ruptured acute appendicitis. Patient was treated conservatively with nasogastric decompression, intravenous fluids, and antibiotics. She later underwent CT guided drainage of a rim-enhancing fluid collection and her symptoms eventually resolved. She returned a week later and a CT imaging showed high grade distal small bowel obstruction, and findings were a 4.5 cm diameter cecal mass. She underwent an exploratory laparotomy and modified right hemicolectomy with ileostomy for. She had an uneventful postoperative course. Pathology revealed poorly differentiated adenocarcinoma of the cecum stage III T4N1Mx. Appendectomy for appendicitis is the most commonly performed emergency operation in the world. Appendicitis are often rare in elderly, with atypical or delayed presentation and expanded differential diagnosis, making preoperative diagnosis challenging. With the increase overall risk of cancer in this age group, occult colonic carcinoma should be high in the differential diagnosis. Three mechanisms potentially leading to obstruction of the appendiceal lumen by the tumor includes: immediate proximity to the lumen, inflammatory changes from the tumor, back pressure on the cecum causing obstruction of the appendix. Despite advances in imaging, local inflammation, collections, and masses may be misleading. The diagnostic accuracy of CT scan reportedly can be as low as 54% for cecal tumors.

Bowel Ischemia Score Predicts Early Operation in Patients With Adhesive Small Bowel Obstruction

2021 ◽  
pp. 000313482098882
Author(s):  
Rachel S. Morris ◽  
Patrick Murphy ◽  
Kelly Boyle ◽  
Louis Somberg ◽  
Travis Webb ◽  
...  
Keyword(s):  
Small Bowel ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Characteristic Curve ◽  
Small Bowel Resection ◽  
Bowel Ischemia ◽  
Operative Intervention ◽  
Early Operation ◽  
Adhesive Small Bowel Obstruction

Background Nonoperative management of adhesive small bowel obstruction (SBO) is successful in up to 80% of patients. Current recommendations advocate for computed tomography (CT) scan in all patients with SBO to supplement surgical decision-making. The hypothesis of this study was that cumulative findings on CT would predict the need for operative intervention in the setting of SBO. Methods This is an analysis of a retrospectively and prospectively collected adhesive SBO database over a 6-year period. A Bowel Ischemia Score (BIS) was developed based on the Eastern Association for the Surgery of Trauma guidelines of CT findings suggestive of bowel ischemia. One point was assigned for each of the six variables. Early operation was defined as surgery within 6 hours of CT scan. Results Of the 275 patients in the database, 249 (90.5%) underwent CT scan. The operative rate was 28.3% with a median time from CT to operation of 21 hours (Interquartile range 5.2-59.2 hours). Most patients (166/217, 76.4%) with a BIS of 0 or 1 were successfully managed nonoperatively, whereas the majority of those with a BIS of 3 required operative intervention (5/6, 83.3%). The discrimination (area under the receiver operating characteristic curve) of BIS for early surgery, any operative intervention, and small bowel resection were 0.83, 0.72, and 0.61, respectively. Conclusion The cumulative signs of bowel ischemia on CT scan represented by BIS, rather than the presence or absence of any one finding, correlate with the need for early operative intervention.

The Role of Laparoscopy in Small Bowel Obstruction After Previous Laparotomy for Trauma: An Initial Report

2011 ◽  
Vol 77 (2) ◽  
pp. 184-187
Author(s):  
Jon D. Simmons ◽  
Emily A. Rogers ◽  
John M. Porter ◽  
Naveed Ahmed
Keyword(s):  
Small Bowel ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Transition Zone ◽  
Bowel Obstruction ◽  
Laparoscopic Approach ◽  
Effective Characteristics ◽  
Initial Report ◽  
Laparoscopic Adhesiolysis ◽  
Previous Laparotomy

Presently, there are no guidelines to help predict which patients are more likely to have successful laparoscopic adhesiolysis. We attempt to define which preoperative characteristics of trauma patients who later develop small bowel obstruction are most amenable to a laparoscopic operation. We did a retrospective review of all patients with small bowel obstruction after previous laparotomy for trauma. For the patients that received an operation to relieve the obstruction, the location of transition zone via CT scan and location of the previous abdominal scar were recorded. A previous upper abdominal surgical incision and a transition zone outside of the pelvis on CT scan were preoperative predictors of a successful laparoscopic adhesiolysis. The laparoscopic group had a shorter length of stay. Laparoscopic surgery as the initial operative approach in the management of SBO after previous laparotomy for trauma is safe and effective. Characteristics that make the laparoscopic approach most favorable are CT transition point above the pelvis and previous midline incision above umbilicus.

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