Surgery in adhesive small bowel obstruction on basis of computed tomography: A prospective analysis

Background: Adhesive small bowel obstruction (ASBO) is the commonest form of small bowel obstruction. The treatment regime for ASBO is not universal. Contrast-enhanced computed tomography (CECT) has been advocated as a valuable procedure to evaluate ASBO. The aim of the present study was to evaluate the contribution of CECT in decision making in the management of patients with ASBO due to postoperative adhesions. Materials and Methods: The duration of this study was 2 years. All patients clinically diagnosed as ASBO with history of clinical symptoms for more than 24 h and any abdominal operation more than a month ago were included in this study. They underwent CECT, which was evaluated for the presence of dilated bowel loops proximal to the transition zone and collapsed distal small bowel loop, presence of complication viz. strangulation and closed loop/volvulus. Results: A total of 30 patients was evaluated. Based on CT findings, the level of obstruction was determined in all the 30 patients. The level of obstruction could be confirmed in nine patients, in which laparotomy was performed, and was same. Complicated small bowel obstruction was predicted in ten patients. The diagnostic accuracy of CT scan was excellent having sensitivity of 100%, specificity of 95.3%, and accuracy of 96.7%. Conclusion: Contrast-enhanced computed tomography abdomen appears to be a safe, quick to perform, and reliable adjunct to clinical examination in the management of patients with ASBO. It is sensitive, specific, and accurate for diagnosis of obstruction, detection of level of obstruction, and complication of obstruction. CT scan appears to be able to sort patients of complicated ASBO, who will require immediate surgical management.