Diagnostic Value of Plain and Contrast Radiography, and Multi-slice Computed Tomography in Diagnosing Intestinal Obstruction in Different Locations

Evaluation of Multidetector Computed Tomography in the Diagnosis of Intestinal Obstruction

Background Acute intestinal obstruction is a commonly encountered surgical emergency that is prevalent worldwide and has substantial morbidity and fatality rates. Therefore, swift and precise diagnosis is essential. While mortality rates in urban areas have declined due to timely medical intervention following early detection, the situation contrasts starkly in rural areas. Delays in presentations often lead to complications because of hesitancy toward surgery, economic challenges, and limited access to healthcare information. Therefore, this study aimed to evaluate how well multidetector computed tomography (MDCT) can help determine the site, cause, and level of intestinal obstruction compared to what the surgeons confirmed intraoperatively. Methodology A prospective study involving 101 patients was conducted at a tertiary care center in western Maharashtra from July 2022 to July 2024. The emergency department referred patients with clinical symptoms such as nausea and vomiting, abdominal distension, abdominal pain, inability to pass flatus, constipation, or diarrhea, which are commonly seen with intestinal obstruction. The study involved all patients who underwent a contrast-enhanced MDCT scan using both intravenous and oral contrast agents. We selected patients from both genders, regardless of their age; however, considerations were taken to include characteristics convenient and relevant to the study. Patients with abnormal serum creatinine levels or allergies to contrast were excluded from the study. We conducted CT examinations, noting findings such as the transition point between the dilated and collapsed loops, mesenteric fat stranding, and intestinal dilatation. An experienced radiologist made the final report, and the operating surgeons' notes on laparoscopy or open surgery for the same patient were reviewed to understand the operative findings. Results MDCT scans had high diagnostic accuracy for small and large bowel obstruction. Of the 101 patients, the mean age was 43.7 years. There were 70 (69.30%) males and 31 (30.69%) females. Sensitivity was 100%, specificity was 98.1%, positive predictive value was 83.7%, and negative predictive value was 100%. Conclusions MDCT demonstrated high sensitivity and specificity for diagnosing and determining the underlying cause of intestinal obstruction. It identified the location of the obstruction and discerned whether it originated from intrinsic, extrinsic, or intraluminal factors.

[Standardization of surgical care for malignant colonic obstruction]

AIM

To standardize surgical care for malignant colonic obstruction.

MATERIAL AND METHODS

There were 572 patients with malignant colonic obstruction: 247 of them were hospitalized in 2011-2013 (I group); 325 - in 2014-2017 (group II). Forty-six patients underwent medication; 302 - acute resection; 141 - stoma construction; 83 - stent deployment. Elective surgery and radiation or chemotherapy was performed after 0.5-6 months in 110 patients of group II. Acute resection was more common in I group, elective resection - in group II. Early and long-term results including Kaplan-Meier 3-year overall survival were compared in both groups.

RESULTS

Complications occurred in 46.69% (group I) and 21% (group II). Postoperative mortality was significantly higher in group I compared with II group: 26.11 and 10.33%, respectively. Three-year overall survival was higher in group I compared with group II: 0.82 and 0.69, respectively.

CONCLUSION

Advisability of new two-stage surgical standard is confirmed for malignant colonic obstruction. Stoma formation and stenting may be a valid alternative in some patients with malignant colonic obstruction due to significantly lower postoperative mortality.

[The optimal terms of the second stage of treatment of patients with malignant colonic obstruction]

AIM

To determine the optimal terms of the second stage of treatment of patients with malignant colonic obstruction.

MATERIAL AND METHODS

There were 110 patients with colorectal cancer stage T_3-4N₀M₀ (groups I-III, n=69) and T_3-4N_0-2M_0-1 (group IV, n=41). Everybody has been previously treated for colonic obstruction 0,5-6 months ago: stoma in 62 cases, stenting - in 48 cases. Elective radical surgery and radiotherapy and/or chemotherapy were applied in 2 (I group, n=23), 3 (II, n=23), 4 (III, n=23) weeks or 4-6 months (IV, n=41) after colonic decompression. The optimal terms of radical surgery are determined depending on CT-data, histological examination.

RESULTS

Bowel wall thickness was significantly higher in I-II groups compared with III-IV groups: 3.7; 2.5; 1.9; 1.7, respectively (p≤0,5). The maximum number of tumor emboli was found in III-IV groups. Signs of focal colitis were absent in III-IV groups.

CONCLUSION

The expediency of the new surgical standard is confirmed. Bridging strategy (stenting and stoma) may be a valid alternative in some patients with malignant colonic obstruction due to reduced postoperative mortality. The optimal terms for resection in patients with local cancer is 4 weeks after colonic decompression, in locally advanced cancer - 4-6 months.

[Managerial and methodological aspects of emergency surgery for malignant colonic obstruction]

AIM

To determine the most feasible treatment strategy for malignant colonic obstruction.

MATERIAL AND METHODS

There were 427 patients with malignant colonic obstruction who were hospitalized for emergency indications. 30 of them were treated with medical therapy; 286 - underwent acute resection; 43 - stoma construction; 68 - stents deployment. 64 out of 427 patients underwent elective restorative/radical surgery and radio- or chemotherapy in 1-8 months. 3-year Kaplan-Meier survival was assessed.

RESULTS

Complications occurred in 58% after acute resection and in 32.6% and 8.8% after stoma and stent deployment, respectively. Postoperative mortality was significantly lower after palliative surgery (stent or stoma) compared with acute resection: 2.9%, 18.6%, 29.37%, respectively. 3-year survival was higher after elective resections compared with emergency resection group: 0,81 и 0,68 respectively.

CONCLUSION

Bridging strategy (stoma/stents) may be a valid alternative in some patients with malignant colonic obstruction due to significantly reduced postoperative mortality. Acute surgery for malignant colonic obstruction should only be carried out by appropriately trained surgeons at multi-field hospital.