ACCURACY OF CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FINDINGS IN DIAGNOSING THE CAUSE OF SMALL BOWEL OBSTRUCTION

Abstract

Objective: Prospective evaluation of the diagnostic accuracy of Contrast-Enhanced Computed Tomography (CECT) in diagnosing small bowel obstruction (SBO), detecting its causes and complications in patients with SBO.

Study Design: Prospective comparative study

Place and duration of study: Combined Military Hospital Kharian, Pakistan, from  September 2024 to  February 2025.

Methodology: Adult patients with clinical presentation of SBO who underwent CECT followed by exploratory laparotomy or clinical resolution with negative follow-up CECT as the reference standard. Diagnostic accuracy parameters, which were used were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.

Results: Two hundred patients were studied with mean age 54.14 ± 17.48 years, male 52.5% and female 47.5%. Out of these, 109 patients (54.5%) had confirmed SBO on exploration. CECT demonstrated sensitivity of 91.7%, specificity of 89.0%, PPV of 90.9%, NPV of 90.0%, and overall accuracy of 90.5%. The most common cause (37.6%) was intestinal adhesions, followed by hernias (20.2%) and tumors (14.7%). The accuracy of CECT in identifying the cause in 87.2% of cases was proven, and the transition point marking was correct in 91.7% of intraoperatively confirmed SBO cases. 27 patients had mesenteric ischemia and bowel perforation (24.7% of cases).

Conclusion: CECT proves excellent diagnostic accuracy in the diagnosis of SBO with high sensitivity and specificity. CECT is significantly reliable in identifying the etiology and complications of SBO, proving it a very valuable addition to clinical decision-making.