Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Multiplanar Imaging Evaluation of Specific Signs in Identifying 'Closed Loop Small Bowel Obstruction' with Multidetector Computed Tomography
Çok Düzlemli Reformasyon Görüntüleme Özelliği Kullanılarak Kapalı Ans Tipi Bağırsak Obstrüksiyonunu Tanımlayan Özel Bulguların Çok Kesitli Bilgisayarlı Tomografi ile Değerlendirilmesi
Kemal Murat HABERALa, Koray HEKİMOĞLUa, Mahir KIRNAPb
Departments of
aRadiology,
bGeneral Surgery Başkent University Faculty of Medicine, Ankara, TURKEY
Turkiye Klinikleri J Med Sci. 2019;39(4):402-8
doi: 10.5336/medsci.2018-63298
Article Language: EN
Full Text
ABSTRACT
 Objective: Closed-loop obstruction (CLO) is a relatively uncommon clinical entity. Ischemic changes are commonly associated with this type of obstruction. Early diagnosis becomes very critical to choose the pathway to manage the patients, surgical or medical and can be also lifesaving. The aim of this study was to determine the diagnostic impact of multiplanar evaluation of specific signs in identifying CLO with multidetector computed tomography (MDCT). Material and Methods: Between June 2012 and December 2017, a retrospective search has been done from medical records of hospital information system for the words 'closed-loop, small bowel obstruction' on CT reports for adult patients (>18 years of age) undergoing MDCT imaging. One hundred and six patients, who meet the criteria, were included in the study. Multidetector computed tomography exams were performed with 16 slices scanner. Images were then evaluated by multiplanar reformatting on the workstation in terms of specific findings of CLO. The results were correlated with the surgical diagnosis. The sensitivity, the specifity and the accuracy of multiplanar MDCT evaluation were calculated. Results: We have diagnosed sixty-two patients with CLO with specific signs. All of the cases had dilated U/C shaped bowel loops. Forty patients had the beak sign, twenty-five had mesenteric congestion sign, ten had radial distribution, and four of them had the whirl sign. Sixteen patients had MDCT signs of strangulation including intestinal pneumatosis, thickening of the bowel wall, mesenteric congestion, engorgement of mesenteric vessels, increased haziness and blurring of the mesenteric structures. Twelve patients were excluded from the study due to missing surgical data. Fifty of the 62 patients underwent surgery in our hospital. There was no statistically significant difference between ischemia at the surgery and correct diagnosis of CLO at MDCT (p=0.88). The mean sensitivity, specificity, and accuracy for the detection of CLO were found to be 94%, 90%, and 95% respectively. Conclusion: Multidetector computed tomography with the capability of multi planar imaging is a valuable modality for demonstrating the specific signs of CLO.

Keywords: Intestinal obstruction; mesenteric vascular occlusion; adhesions; multidetector computed tomography
ÖZET
 Amaç: Kapalı ans tipi barsak obstrüksiyonu (KATO) nadir görülen bir durumdur. İskemik değişiklikler sıklıkla bu tip barsak tıkanıklığına eşlik etmektedir. Erken tanı hayat kurtarıcı olmasının yanında hastaların cerrahi veya medikal yolla tedavi seçimini yönlendirmede önemlidir. Bu çalışmanın amacı, KATO'nun çok kesitli bilgisayarlı tomografi (ÇKBT) ile tanımlanmasında özel işaretlerin çok düzlemli reformasyon görüntüleme özelliği kullanılarak değerlendirilmesinin tanısal etkisini belirlemekti. Gereç ve Yöntemler: Haziran 2012 ile Aralık 2017 arasında, ÇKBT görüntülemesi yapılan erişkin hastalarda (yaş >18) BT raporlarında 'kapalı ans, ince barsak obstrüksiyonu' kelimeleri için hastane bilgi sisteminin tıbbi kayıtlardan geriye dönük bir araştırma yapıldı. Kriterlere uyan 106 hasta çalışmaya dahil edildi. Çok kesitli bilgisayarlı tomografi 16 detektörlü BT cihazı ile gerçekleştirildi. Görüntüler daha sonra KATO'nun spesifik bulguları açısından iş istasyonunda multiplanar reformasyon görüntüler oluşturularak değerlendirildi. Sonuçlar kesin tanı ile korele edildi. ÇKBT'nin duyarlılığı, özgüllüğü ve doğruluğu hesaplandı. Bulgular: Kapalı ans tipi barsak obstrüksiyonu olan 62 hasta spesifik bulgularla teşhis edildi. Olguların tümünde U/C şeklinde dilate barsak ansları izlendi. Kırk hastada gaga işareti, yirmi beş hastada mezenterik tıkanıklık işareti, on hastada radyal dağılım, dört hastada burgu işareti vardı. On altı hastada intestinal pnömatozis, barsak duvar kalınlaşması, mezenterik damarların tıkanması, mezenterik heterojenite gibi strangülasyon bulguları saptandı. On iki hasta ameliyat raporlarına ulaşılamadığından çalışmadan çıkarıldı. Altmış iki hastanın 50'si hastanemizde ameliyat edildi. Ameliyatta iskemi ile ÇKBT'de KATO'nun doğru tanısı arasında istatistiksel olarak anlamlı bir fark saptanmadı. Kapalı ans tipi barsak obstrüksiyonu için, KATO saptanmada duyarlılık, özgüllük ve doğruluk sırasıyla %94, %90 ve %95 olarak hesaplandı. Sonuç: Çok düzlemli reformasyon görüntülerinin yeterliliğine sahip ÇKBT, KATO'nun spesifik belirtilerini göstermek için değerli bir yöntemdir.

Anahtar Kelimeler: İntestinal obstrüksiyon; mezenterik damar tıkanıklığı; adezyon; çok kesitli bigisayarlı tomografi
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