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A significant proportion of patients with intestinal obstruction will be evaluated with a CT scan of the abdomen. This study presents a group of 97 patients diagnosed with mechanical obstruction or ileus on CT scan over a 16-month period at a community based teaching hospital and follows the further management of these patients. Our study shows that 43.3 per cent of patients with mechanical obstruction, diagnosed by CT scan, eventually needed surgical treatment. On the other hand, even when CT indicates ileus, 20 per cent of these patients may still require surgical intervention.
Intestinal obstruction is responsible for 20 per cent of emergent surgical admissions.1 In the last hundred years, mortality from small bowel obstruction has declined from fifty per cent to less than three per cent.2 A significant number of patients with intestinal obstruction will be evaluated with a CT scan of the abdomen. This study presents a group of patients diagnosed with mechanical obstruction or ileus on CT scan and follows the further management of these patients.
Patients and Methods
Over a 16-month period from January 2003 to April 2004, all patients with a diagnosis of intestinal obstruction on CT scan were identified at a community based teaching hospital. There were 42 males and 55 females. Their ages ranged from 4 to 97 years with a mean age of 56.8 years. The patients were divided into those read as mechanical obstruction and those read as ileus.
The patients were scanned with a GE QXI (GE, Madison, WI), light speed, four slice scanner with 5-mm cuts. Oral contrast (900 cc of barium for outpatients and gastrograffin for inpatients) was given 90 minutes before the CT. Intravenous contrast with iohexal was given at the time of the CT scan. The CT scans were read by radiologists as either showing mechanical obstruction or ileus. Mechanical bowel obstruction was diagnosed by the presence of proximal dilated bowel and distal collapsed bowel or a transition point, internal hernia, closed loop obstruction, or intussusception. Ileus was diagnosed when there was only bowel dilatation without any transition point.
Results
Over the 16-month period, 97 CT scans were consistent with intestinal obstruction. Of the 67 patients diagnosed with mechanical bowel obstruction, 38 patients were initially managed conservatively and 23 had...