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Colon: Bowel Obstruction Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Colon ❯ Bowel Obstruction

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  • OBJECTIVE. The objective of our study was to evaluate the diagnostic performance of CT in the identification of anastomotic leaks. 


    CONCLUSION. Diagnostic performance of CT was highest when an intraluminal contrast agent was used. Meticulous and careful use of an intraluminal contrast agent is therefore important in this patient population. 
Anastomotic Leaks After
Small- and Large-Bowel Surgery: Diagnostic Performance of CT and the Importance of Intraluminal Contrast Administration 
Samji KB et al.
AJR 2018; 210:1259–1265
  • 
RESULTS. The most sensitive imaging predictor was intraabdominal free fluid (95.3%). Leakage of intraluminal contrast agent was also a highly specific imaging predictor (96.6%). Substantial interobserver agreement was shown for intraabdominal free gas (κ = 0.76) and leakage of intraluminal contrast agent (κ = 0.76). Overall diagnostic performance in correctly identifying surgically confirmed leaks, as assessed by the area under the ROC curve, ranged from 0.76 to 0.86. Diagnostic performance was higher for all readers when intraluminal contrast agent was used and reached the anastomosis, with the exception of one reader, whose di- agnostic performance remained unchanged. 


    Anastomotic Leaks After Small- and Large-Bowel Surgery: Diagnostic Performance of CT and the Importance of Intraluminal Contrast Administration 
Samji KB et al.
AJR 2018; 210:1259–1265
  • 
“A study involving 1223 patients reported an incidence rate of 2.7%. Although leaks usually present within days of the surgery, they can present more than 30 days after surgery. Timely and accurate diagnosis of these leaks is essential for the management of these patients; mortality of patients with an anastomotic leak after bowel surgery can range between 7.5% and 39%.”


    Anastomotic Leaks After Small- and Large-Bowel Surgery: Diagnostic Performance of CT and the Importance of Intraluminal Contrast Administration 
Samji KB et al.
AJR 2018; 210:1259–1265
  • 
“The most sensitive findings associated with surgically proven leaks were disseminated intraabdominal free fluid (95.3%) and gas (84.3%). Perianastomotic inflammatory stranding, fluid, and gas were also highly sensitive findings (81.8%, 71.2%, and 67.2%, re- spectively). Reduced bowel wall enhancement and bowel obstruction at the anastomosis were the least sensitive findings (6.7% and 4.7%) but were highly specific (96.1% and 99.5%); however, these findings were rarely present.”

    
Anastomotic Leaks After Small- and Large-Bowel Surgery: Diagnostic Performance of CT and the Importance of Intraluminal Contrast Administration 
Samji KB et al.
AJR 2018; 210:1259–1265
  • “In conclusion, although there is some over- lap of CT findings in patients with and in those without anastomotic leaks, the identification of certain highly sensitive and specific findings—including leakage of intraluminal contrast agent outside the bowel lumen—should assist the radiologist in correctly identifying these leaks. Although the overall sensitivity of CT for the detection of anastomotic leakage remains low, diagnostic performance was improved by using an intraluminal contrast agent and ensuring that it reaches the anastomosis. This study strongly suggests that meticulous and careful use of intraluminal contrast agents (orally or rectally administered) is important in this patient population.”


    Anastomotic Leaks After Small- and Large-Bowel Surgery: Diagnostic Performance of CT and the Importance of Intraluminal Contrast Administration 
Samji KB et al.
AJR 2018; 210:1259–1265
  • “This study strongly suggests that meticulous and careful use of intraluminal contrast agents (orally or rectally administered) is important in this patient population.”

    
Anastomotic Leaks After Small- and Large-Bowel Surgery: Diagnostic Performance of CT and the Importance of Intraluminal Contrast Administration 
Samji KB et al.

  • "This pictorial essay presents CT imaging features of bowel obstruction with additional consideration given to the role that multidetector CT may play in refining it."

    Bowel Obstruction Revealed by Multidetector CT
    Khurana B et al.
    AJR 2002;178:1139-1144
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