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CT Scan Findings Do Not Predict Outcome of Nonoperative Management in Small Bowel Obstruction
Victor E Pricolo, *Kirellos Zamary, *Jennifer Foster, *Filomena Curley, *Steven Reinert
Rhode Island Hospital, Brown University, Providence, RI

Objectives: Routine use of computerized tomography (CT) in evaluating patients with small bowel obstruction may not be cost-effective. The study purpose was to investigate the ability of CT findings to predict need for operative intervention in patients admitted to hospital for small bowel obstruction and initially managed nonoperatively.
Design: Retrospective chart review study. Statistical analysis was done with independent-samples t-test and chi-square.
Setting: Tertiary care academic medical center.
Patients: Of 200 consecutive patients admitted with small bowel obstruction, 108 (53 male and 55 female, age range 23-96 years), were included in the study, as they received non-operative management. Exclusion criteria were: clinical or imaging findings mandating emergent surgical intervention (e.g. peritonitis, free air, incarcerated hernia, et al.). Additional patient informations (e.g. type and number of previous abdominal operations, benign or malignant disease, et al.) were recorded as well.
Main Outcome Measures: The correlation of certain radiographic findings mentioned in the CT report (transition point, small bowel feces, high grade obstruction, and abnormal vascular course) with need for operative management.
Results: For the entire group, only 18 patients (16.7%) failed conservative management and required operative intervention, while the other 90 (83.3%) were successfully discharged after nonoperative treatment. The correlation between CT scan findings and treatment outcome is reported in table 1.
Conclusions: CT scan findings do not provide additional information that significantly affects management in most patients with small bowel obstruction. Its routine use should be reconsidered and possibly limited to certain patients based on additional clinical and laboratory data.
Table 1
CT findingsN patientsOp. Mgmt..Nonop. Mgmt.p value
Trans. Point7813 (16.7%)650.680 NS
SB Feces353 (8.6%)320.199 NS
High Grade142 (14.3%)120.813 NS
Abn. Vasc.3030.439 NS

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