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Bilgisayarlı tomografide bağırsak duvar özelliklerinin ve kontrastlanmasının bağırsak obstrüksiyonu etiyolojisini belirlemedeki rolü

Yıl 2020, Cilt: 59 Sayı: 4, 294 - 301, 30.12.2020

Ezgi Güler , Sevcan Türk Timur Köse , Mustafa Harman , Nevra Zehra Elmas

https://doi.org/10.19161/etd.834233

Öz

Amaç: Bağırsak duvar kalınlık artışı olan olgulardaki bağırsak duvar özellikleri ve bilgisayarlı tomografi (BT) bulgularının bağırsak obstrüksiyonunun etiyolojisini belirlemedeki rolünü araştırmaktır.
Gereç ve Yöntem: Ocak 2015 ile Eylül 2016 tarihleri arasında hastanemize başvuran ve BT incelemelerinde bağırsak duvar kalınlaşmasının eşlik ettiği bağırsak obstrüksiyonu mevcut olguların incelemeleri retrospektif olarak değerlendirildi. Bağırsak duvar kalınlığı, arteriyel ve portal venöz faz kontrastlı görüntülerde bağırsak duvar atenüasyonu ölçümleri yapıldı. İnce bağırsak feçes işareti, asit, lenfadenopati, tarak işareti, mezenterik ödem, mezenterik damar trombozu varlığı kaydedildi. Bağırsak obstrüksiyonu nedenleri neoplazi, adhezyon, iskemi ve inflamatuvar bağırsak hastalığı (İBH) olarak dört ana gruba ayrıldı. Gruplar arasında karşılaştırma Mann-Whitney U testi kullanılarak yapıldı. Etiyoloji ve değişkenler arasındaki ilişkinin değerlendirilmesinde Pearson ki-kare testi kullanıldı. Bağırsak duvar kalınlığı ve bağırsak duvar atenüasyonu oranı göz önüne alındığında obstrüksiyon etiyolojisini değerlendirme amacıyla ROC analizi yapıldı.
Bulgular: Bağırsak obstrüksiyonu ile birlikte bağırsak duvar kalınlık artışı olan 63 olgu (40 erkek, 23 kadın; ortanca yaş: 62) saptandı. Bağırsak duvar kalınlığı göz önüne alındığında neoplazi-adezyon, neoplazi-İBH ve neoplazi-iskemi gruplarının karşılaştırılmasında istatistiksel olarak anlamlı fark saptandı. Bağırsak duvar kalınlığı ≥9,5 mm olan olgularda neoplazi tanısı için duyarlılık %85,7, özgüllük %92,5 olarak bulundu. Bağırsak duvar atenüasyonu oranı yönünden yapılan değerlendirmede iskemi ve diğer gruplar arasında anlamlı fark saptandı. Bağırsak duvar atenüasyonu oranı ≤-0,5 olan olgularda iskemi tanısı için duyarlılık %90,9, özgüllük %74,4 olarak tespit edildi. Lenfadenopati, feçes işareti, tarak işareti, damar trombozu varlığı yönünden grupların karşılaştırılmasında anlamlı farklar saptandı (p<0,05).
Sonuç: Bilgisayarlı tomografide saptanan bağırsak duvar kalınlık artışındaki farklar neoplaziyi bağırsak obstrüksiyonuna yol açan diğer nedenlerden ayırt etmede yardımcıdır. Bağırsak duvar atenüasyonu oranı iskemiyi ayırt etmek için yararlı olabilir.

Anahtar Kelimeler

Bağırsak obstrüksiyonu neoplazi iskemi inflamatuvar bağırsak hastalığı

Kaynakça

  • Nicolaou S, Kai B, Ho S, Su J, Ahamed K. Imaging of acute small-bowel obstruction. AJR Am J Roentgenol 2005; 185 (4): 1036-44.
  • Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg 2006; 203 (2): 170-6.
  • Markogiannakis H, Messaris E, Dardamanis D, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol 2007; 13 (3): 432-7. Delabrousse E, Destrumelle N, Brunelle S, Clair C, Mantion G, Kastler B. CT of small bowel obstruction in adults. Abdom Imaging 2003; 28 (2): 257-66.
  • Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: what to look for. Radiographics 2009; 29 (2): 423-39.
  • Jaffe T, Thompson WM. Large-bowel obstruction in the adult: classic radiographic and CT findings, etiology, and mimics. Radiology 2015;275(3):651-63.
  • Frager D, Medwid SW, Baer JW, Mollinelli B, Friedman M. CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause. AJR Am J Roentgenol 1994; 162 (1): 37-41.
  • Fukuya T, Hawes DR, Lu CC, Chang PJ, Barloon TJ. CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol 1992; 158 (4): 765-9.
  • Gore RM, Balthazar EJ, Ghahremani GG, Miller FH. CT features of ulcerative colitis and Crohn's disease. AJR Am J Roentgenol 1996; 167 (1): 3-15.
  • James S, Balfe DM, Lee JK, Picus D. Small-bowel disease: categorization by CT examination. AJR Am J Roentgenol 1987; 148 (5): 863-8.
  • Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. Radiographics 2000; 20 (2): 399-418.
  • Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 2001; 176 (5): 1105-16.
  • Mayo-Smith WW, Wittenberg J, Bennett GL, Gervais DA, Gazelle GS, Mueller PR. The CT small bowel faeces sign: description and clinical significance. Clin Radiol 1995; 50 (11): 765-7.
  • Madureira AJ. The comb sign. Radiology 2004; 230 (3):783-4.
  • Hwang JY, Lee JK, Lee JE, Baek SY. Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion. Eur Radiol 2009; 19 (10): 2425-31.
  • Sreenarasimhaiah J. Diagnosis and management of intestinal ischaemic disorders. BMJ 2003; 326 (7403): 1372-6.
  • Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 2003; 229 (1): 91-8.
  • Millet I, Taourel P, Ruyer A, Molinari N. Value of CT findings to predict surgical ischemia in small bowel obstruction: A systematic review and meta-analysis. Eur Radiol 2015; 25 (6): 1823-35.
  • Cox VL, Tahvildari AM, Johnson B, Wei W, Jeffrey RB. Bowel obstruction complicated by ischemia: analysis of CT findings. Abdom Radiol (NY) 2018; 43 (12): 3227-32.
  • Chuong AM, Corno L, Beaussier H, et al. Assessment of bowel wall enhancement for the diagnosis of intestinal ischemia in patients with small bowel obstruction: value of adding unenhanced CT to contrast-enhanced CT. Radiology 2016; 280 (1):98-107.
  • Rao PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis. Radiology 1997; 202: 145-9.
  • Taourel PG, Deneuville M, Pradel JA, Regent D, Bruel JM. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 1996; 199: 623-6

The role of characteristics and enhancement of bowel wall on computed tomography in differentiating the etiology of bowel obstruction

Yıl 2020, Cilt: 59 Sayı: 4, 294 - 301, 30.12.2020

Ezgi Güler , Sevcan Türk Timur Köse , Mustafa Harman , Nevra Zehra Elmas

https://doi.org/10.19161/etd.834233

Öz

Aim: To evaluate the bowel wall characteristics and findings on computed tomography (CT) in distinguishing the etiology of bowel obstruction accompanied with bowel wall thickening.
Materials and Methods: CT scans of patients with bowel obstruction accompanied with thickened bowel walls, who were admitted to our institution between January 2015 and September 2016 were retrospectively reviewed. Bowel wall thickness and attenuation on arterial and portal venous phase images were measured. Presence of small-bowel feces sign, ascites, lymphadenopathy, comb sign, mesenteric edema and thrombosis of vessels were noted. Causes of bowel obstruction were divided into 4 main groups: neoplasia, adhesions, ischemia, inflammatory bowel disease (IBD). Comparisons between groups were evaluated using Mann-Whitney U test. Pearson’s chi-square test was applied to assess associations between variables and etiology. ROC analysis was performed to evaluate the relationship between the etiology of obstruction and bowel wall thickness or attenuation ratio.
Results: Sixty-three patients (40 men, 23 women; median age:62 years) were identified. Comparisons of neoplasm-adhesion, neoplasm-IBD, and neoplasm-ischemia groups were statistically significant for bowel wall thickening. When the bowel wall thickness was ≥9.5 mm, the sensitivity and specificity of the diagnosis of neoplasm were 85.7% and 92.5%, respectively. There was a statistically significant difference between ischemia and other groups in terms of bowel wall attenuation ratio. The bowel wall attenuation ratio of ≤-0,5 enabled the diagnosis of ischemia with a sensitivity and specificity of %90.9 and %74.4, respectively. Presence of lymphadenopathy, feces sign, comb sign and thrombosis of vessels were significantly associated with comparisons of groups (p<0.05).
Conclusion: Differences of bowel wall thickening on CT can be helpful in differentiating neoplasm from other causes of bowel obstruction. Bowel wall attenuation ratio can be useful in distinguishing ischemia.

Anahtar Kelimeler

intestinal obstruction neoplasm ischemia inflammatory bowel disease

Kaynakça

  • Nicolaou S, Kai B, Ho S, Su J, Ahamed K. Imaging of acute small-bowel obstruction. AJR Am J Roentgenol 2005; 185 (4): 1036-44.
  • Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg 2006; 203 (2): 170-6.
  • Markogiannakis H, Messaris E, Dardamanis D, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol 2007; 13 (3): 432-7. Delabrousse E, Destrumelle N, Brunelle S, Clair C, Mantion G, Kastler B. CT of small bowel obstruction in adults. Abdom Imaging 2003; 28 (2): 257-66.
  • Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: what to look for. Radiographics 2009; 29 (2): 423-39.
  • Jaffe T, Thompson WM. Large-bowel obstruction in the adult: classic radiographic and CT findings, etiology, and mimics. Radiology 2015;275(3):651-63.
  • Frager D, Medwid SW, Baer JW, Mollinelli B, Friedman M. CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause. AJR Am J Roentgenol 1994; 162 (1): 37-41.
  • Fukuya T, Hawes DR, Lu CC, Chang PJ, Barloon TJ. CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol 1992; 158 (4): 765-9.
  • Gore RM, Balthazar EJ, Ghahremani GG, Miller FH. CT features of ulcerative colitis and Crohn's disease. AJR Am J Roentgenol 1996; 167 (1): 3-15.
  • James S, Balfe DM, Lee JK, Picus D. Small-bowel disease: categorization by CT examination. AJR Am J Roentgenol 1987; 148 (5): 863-8.
  • Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. Radiographics 2000; 20 (2): 399-418.
  • Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 2001; 176 (5): 1105-16.
  • Mayo-Smith WW, Wittenberg J, Bennett GL, Gervais DA, Gazelle GS, Mueller PR. The CT small bowel faeces sign: description and clinical significance. Clin Radiol 1995; 50 (11): 765-7.
  • Madureira AJ. The comb sign. Radiology 2004; 230 (3):783-4.
  • Hwang JY, Lee JK, Lee JE, Baek SY. Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion. Eur Radiol 2009; 19 (10): 2425-31.
  • Sreenarasimhaiah J. Diagnosis and management of intestinal ischaemic disorders. BMJ 2003; 326 (7403): 1372-6.
  • Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 2003; 229 (1): 91-8.
  • Millet I, Taourel P, Ruyer A, Molinari N. Value of CT findings to predict surgical ischemia in small bowel obstruction: A systematic review and meta-analysis. Eur Radiol 2015; 25 (6): 1823-35.
  • Cox VL, Tahvildari AM, Johnson B, Wei W, Jeffrey RB. Bowel obstruction complicated by ischemia: analysis of CT findings. Abdom Radiol (NY) 2018; 43 (12): 3227-32.
  • Chuong AM, Corno L, Beaussier H, et al. Assessment of bowel wall enhancement for the diagnosis of intestinal ischemia in patients with small bowel obstruction: value of adding unenhanced CT to contrast-enhanced CT. Radiology 2016; 280 (1):98-107.
  • Rao PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis. Radiology 1997; 202: 145-9.
  • Taourel PG, Deneuville M, Pradel JA, Regent D, Bruel JM. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 1996; 199: 623-6
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Ezgi Güler 0000-0002-8028-0350

Sevcan Türk 0000-0003-0243-864X

Timur Köse 0000-0002-5238-9738

Mustafa Harman 0000-0001-9234-887X

Nevra Zehra Elmas 0000-0002-0074-5673

Yayımlanma Tarihi 30 Aralık 2020
Gönderilme Tarihi 1 Ağustos 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 59 Sayı: 4

Kaynak Göster

Vancouver Güler E, Türk S, Köse T, Harman M, Elmas NZ. Bilgisayarlı tomografide bağırsak duvar özelliklerinin ve kontrastlanmasının bağırsak obstrüksiyonu etiyolojisini belirlemedeki rolü. ETD. 2020;59(4):294-301.
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