Background
Frequently, radiologists emphasize radiographic transition zones (RTZs) on computed
tomography (CT), which are areas of abrupt change from dilated to collapsed bowel,
as pathognomonic for small-bowel obstruction (SBO) diagnosis and location. The relevance
of RTZs to patient management remains unknown. The purpose of this study was to determine
the surgical predictive value and intraoperative accuracy of RTZ.
Methods
A retrospective review of 200 patients with SBO who underwent abdominal CT at a single
institution from 2002 to 2007 was performed. Statistical analysis was conducted using
an unpaired t test, a Chi-square test, and multivariate analysis.
Results
Of the 200 patients with SBO, 150 (75%) had an RTZ. Seventy-five (38%) patients required
operative intervention; 58 (39%) patients had RTZ and 17 (34%) patients did not have
RTZ (P=NS). The presence of RTZ was not associated with increased probability of operative
versus nonoperative management (odds ratio=1.19; 95% confidence interval [0.61–2.32]). The mean time to operative intervention
was 3.6 days. Immediate operative intervention (<24 h) was equivalent in patients with versus without RTZ (57% vs 53%; P=NS) as was intervention for failed nonoperative management (43% vs 47%; P=NS). For patients who required operative intervention, RTZ correlated with intraoperative
site of obstruction in only 31 (63%) patients.
Conclusion
The presence of RTZs does not increase the likelihood of operative intervention or
identify patients who will fail nonoperative management. RTZ should, therefore, not
be used as a major criterion influencing operative versus nonoperative management
decisions in patients with SBO. For patients who required operative intervention,
RTZ had a 63% correlation with intra-operative findings, which makes it a useful adjunct
to pre-operative planning.
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Article info
Publication history
Published online: December 11, 2009
Accepted:
October 2,
2009
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
