การประเมินภาวะเนื้อตายของลำไส้ในผู้ป่วยลำไส้เล็กอุดตันจากพังผืดในช่องท้องโดยใช้การเพิ่ม Attenuation ของสารน้ำในลำไส้จากเอกซเรย์คอมพิวเตอร์ช่องท้อง

Chanika  Maharak; Nattaporn Charoenpak

Authors

Chanika Maharak Phangnga Hospital
Natthaphorn Charoenphak Phangnga Hospital

Keywords:

Small bowel obstruction, Bowel necrosis, CT abdomen

Abstract

Objective: To evaluate the effectiveness of various CT signs in helping to diagnose bowel necrosis in patients with adhesive small bowel obstruction. Including assessing interobserver agreement for each CT sign.

Method: A retrospective review study by searching for patients from medical records in Phangnga Hospital from January 2012 to August 2024 who met the inclusion criteria. Patients in the necrosis group must have a surgical report and pathology confirmation. Thereafter, two radiologists independently reviewed the CT scans for subjective visual assessment and objective measurement. Diagnostic accuracy was then assessed, and the interobserver agreement on the various CT signs was evaluated. Univariable and multivariable analyses of various CT signs for bowel necrosis were also included.

Results: Of the total 194 patients in the study, 18 were in the necrotic group (mean age, 66.8 years; 66.7% women) and 176 in the nonnecrotic group (mean age, 59.2 years; 62.5% women). Increased attenuation of intestinal contents and increased attenuation of intestinal wall had similar high specificity (95.4% and 92.4%, respectively) and accuracy (92.6% and 90.5%, respectively) for predicting bowel necrosis. However, interobserver agreement was a moderate agreement for assessing the contents and the wall (Κ = 0.64 and 0.60, respectively). A difference value of attenuation of intestinal contents of 9 HU or greater was considered increased attenuation of intestinal contents, while a difference value of attenuation of intestinal wall of 8 HU or greater was considered increased attenuation of intestinal wall. Univariable and multivariable analysis showed that increased attenuation of intestinal contents and increased attenuation of the intestinal wall were independent predictors of bowel necrosis (odds ratio = 16.78 and 11.94; P = 0.003 and P = 0.002, respectively).

Conclusion: Increased attenuation of intestinal contents and increased attenuation of intestinal wall have high specificity and high accuracy in helping to predict bowel necrosis in adhesive small bowel obstruction, while the interobserver agreement was moderate . These two CT signs were found to be independent predictors of bowel necrosis.

Keyword: Small bowel obstruction, Bowel necrosis, CT abdomen

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