ARRS 2022 Abstracts

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E2122. A Simple Technique Can Save Lives: Role of CT in Small Bowel Obstruction
Authors
  1. Ahmed Taher; Nazareth Hospital; The University of Texas Health Science Center at Houston
  2. Lynsey Maciolek; The University of Texas Health Science Center at Houston
  3. Latifa Sanhaji; The University of Texas Health Science Center at Houston
Background
Small bowel obstruction (SBO) is one of the most common causes of non-traumatic abdominal emergencies leading to unplanned admissions, with a mortality rate of about 5% or as high as 25% when associated with complications. It accounts for almost 80% of all mechanical bowel obstructions, with the large bowel obstruction (LBO) responsible for the remaining 20%. Both the treatment approach and outcome depend on the prompt and accurate diagnosis of the obstruction and underlying cause. SBO management algorithms have experienced a substantial paradigm shift over the recent decades, contrary to the old surgical model of “never let the sun set or rise on an obstructed viscus,” nowadays, due to the huge advances in diagnostic tools especially in the imaging sector, imaging has become the cornerstone of SBO investigations. Technically, imaging of the small bowel can represent a real challenge. The main factors are the distinctive anatomy it possesses, added to its serpentine and overlapping pattern. Not to mention its mobile nature with both intrinsic peristalsis and extrinsic motion secondary to breathing. The purpose of this exhibit is to highlight the importance of radiologic findings of SBO that are clinically relevant from the surgical perspective.

Educational Goals / Teaching Points
The goals of this exhibit are to review CT technical requirements and findings to diagnose SBO in the emergency department; recognize the causes of SBO and their CT presentations; and assess severity and complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
SBO interferes with the flow of intestinal contents, leading to dilatation of the proximal bowel and decompression of the distal bowel. This obstruction could be acute or chronic and may lead to serious complications such as strangulation, ischemia, necrosis, perforation, peritonitis, sepsis, and even death. The most common risk factor for non-traumatic SBO is the history of abdominal surgeries, followed by hernias and neoplasms, then other risk factors such as intra-abdominal collections, inflammatory bowel diseases (IBD), and foreign bodies. The goals of imaging in a patient with suspected SBO are organized as clinical questions: 1) Is it a true mechanical obstruction or a functional ileus? 2) What is the level of the obstruction? 3) Where is the transition point? 4) How severe is the obstruction? 5) What is the cause of the obstruction? 6) Is there a complication: closed-loop, strangulation, bowel ischemia, or perforation? 7) What is the best approach for management?

Conclusion
As clinicians always rely on clinical information to suspect SBO cases, they almost always need the radiological evaluation to confirm the diagnosis. Successful identification can help guide surgeons on how to manage these cases allowing for optimal outcomes.