الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Radiology assumes considerable relevance in assisting the therapeutic decision of the surgeon in cases of BO. MDCT and Multiplanar reformats views may help identify the site, level, cause of obstruction and detecting complications when axial findings are indeterminate.
This study was conducted on 30 patients admitted to the Alexandria university hospital with history and clinical examination suggestive of bowel obstruction to assess the role of MDCT in evaluating patients with bowel obstruction.
All patients were subjected for MDCT scans for the abdomen and pelvis. Images were interpreted by dedicated workstation &post processing software using multi-planner (axial, sagittal and coronal) views and were compared with the final diagnosis that was based on all available clinical and lab information as well as surgical findings at operated cases.
IV contrast was injected in 27 patients with normal creatinine clearance, post contrast images was obtained in venous phase.in some cases with suspected arterial compromise ,post contrast images were obtain in late arterial and venous phase . Oral contrast was used in four patients (neutral contrast) and two patients (positive contrast). While enema contrast was used in four cases.
The age of studied patients ranged between 2 to 75 years old. 16 cases were females (53 %) and 14 cases were males (47 %). The study showed 23 cases diagnosed as SBO and 5 cases as LBO while 2 cases showed SBO and LBO.
The level of obstruction was detected in all cases however; ileus was diagnosed by absence of the transitional zone.
The cause of bowel obstruction was diagnosed correctly in 29 cases. Ileus was seen in 5 cases while adhesion in four cases, external hernia in four cases, large bowel adenocarcinoma in 3 cases, small bowel secondary neoplasm in two cases, MVO in three cases, intussusception in two cases and one case for each one of the following, gall stone ileus, bezoar, fecal impaction, Crohn’s disease, radiation enteritis and typhoid enteritis.
Closed loop was seen in 5 cases (17%), 2 of them were BO due to adhesion and 2 were due to hernia and the fifth case was sigmoid volvulus. Two cases of the closed loop obstruction showed ischemic changes.
Intestinal obstruction complications were seen in the study in the form of ischemic changes in 7 cases.16 patients showed high grade obstruction with difference in bowel diameter >50% and 14 patients show low grade obstruction. Small bowel feces sign was seen at transitional zone in 8 patients, 7 of them showed high grade obstruction.
Finally, we conclude that MDCT is the modality of choice for diagnosis of bowel obstruction and can differentiate mechanical from functional obstruction and small from large bowel obstruction with identification of level of obstruction, its cause and associated complications. Multiplanar reformats views may help identify the site, level, cause of obstruction and detecting complications when axial findings are indeterminate. Administration of IV contrast is mandatory to assess vascularity of the bowel.