Role of Multidetector Computed Tomography in the Evaluation of Intestinal Obstruction

Background: Intestinal obstruction is responsible for approximately 20% of surgical admissions for acute abdominal conditions. Multidetector computed tomography (MDCT) plays an important role in revealing the site, level, and cause of obstruction and demonstrating threatening signs of bowel inviability. Materials and Methods: This was a prospective study conducted on 40 patients with suspected intestinal obstruction, in the Department of Radiodiagnosis at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala) in collaboration with the Department of Surgery. Computed tomography (CT) scan was done in all the patients suspected of intestinal obstruction with ingenuity CT (64 MDCT, Philips Medical Systems). The study was done with oral contrast (wherever required) and intravenous contrast agents. Results: Out of 40 patients, 27 were males and 13 were females. The most frequently encountered symptom was pain abdomen. The majority of the patients showed markedly dilated gut loops. The level of obstruction was diagnosed in large bowel in 2 patients. Terminal ileum was the most common site of obstruction followed by proximal ileum, jejunum, I-C junction, and rectosigmoid. Adhesion was the most common cause of obstruction followed by abdominal tuberculosis, malignancy, intussusceptions, malrotation, ischemia, and intra-abdominal collections. The final diagnosis was confirmed by laparotomy or histopathological examination. Conclusion: MDCT by using its multiplanar and three-dimensional capabilities is highly accurate and specific in detecting the presence of intestinal obstruction. It can demonstrate the exact site of obstruction in a high percent of cases. It is highly sensitive and specific in diagnosing the cause of obstruction. In addition to primary gut pathology, MDCT can detect various associated and incidental findings which are not suspected clinically.