الفهرس 
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Abstract
When the gut is blocked, either mechanically or functionally, food and waste are unable to move through the body normally. As a result, it accounts for 15–20% of all surgical admissions for sudden stomach discomfort.
Large bowel obstructions (LBOs) may have a variety of causes depending on age, but in adults, sigmoid-level colon cancer accounts for around half of all cases. Acute diverticulitis ranks second among adult causes (involving the sigmoid colon). Ninety percent of LBO cases are brought on by obstructions such tumours or severe diverticulitis.
Although adhesions are the leading cause of small bowel obstruction (SBO), they seldom induce large bowel obstruction (LBO). Bowel ischemia, caused mostly by blockage of the mesenteric arteries, is another condition that may produce symptoms similar to those of intestinal obstruction (adynamic obstruction).
CT scans are now routinely used to check for intestinal blockage. This is because there has been a significant shift in the way blockage is treated, resulting in a smaller percentage of individuals requiring surgery.
Scan times, section collimation, and scan lengths may all be decreased or increased, respectively, with the use of multi-detector computed tomography scanners.
Clinical signs such as abdominal distension, severe abdominal pain, vomiting, and the inability to pass faeces or flatus are used to make a diagnosis of intestinal blockage based on the patient’s history.
CT has a growing role in the diagnosis of intestinal obstruction, including the determination of the presence, degree, level, and cause (extrinsic lesions, intrinsic lesions, intussusception, intraluminal lesions) of obstruction as well as the identification of any associated strangulation. CT also plays an important role in diagnosing the mesenteric vessels obstruction by thrombi by injection of IV contrast media, which causes adynamic bowel obstruction.
Therefore, the aim of this work was to emphasize the role of the MDCT in the evaluation of intestinal obstruction, the underlying causes, and the related conditions and then correlated with the operative findings.
This prospective study was conducted on eighty patients presented by manifestations of acute intestinal obstruction. All patients were examined by multislice CT scanner. Evaluation of each patient at emergency unit by detailed patient history, general and local examination. Resuscitation and management of each case either by conservative treatment or surgical exploration. Then correlation of radiological data with operative findings were done.
Summary of our Results:
• Regarding the final diagnosis of the studied patients, 25 (31.25%) patients had adhesion, 20 (25 %) patients had colorectal cancer, 12 (15 %) patients had obstructive hernia, 3 (3.8 %) patients had gall stone ileus, 5 (6.3 %) patients had sigmoid volvulus, 2 (2.5 %) patients had small intestinal tumor, 4 (5.0 %) patients had MVO, 2 (2.5 %) patients had intussusception, 1 (1.3 %) patient had Meckel’s diverticulitis, 1 (1.3 %) patient had IBD, and 5 (6.3 %) patient had internal hernia.
• Age ranged in the studied patients from 7-75 years, with a mean ± SD of 49.54 ± 16.34 years and a median (IQR) of 53(23) years.The studied patients had 53 (66.3 %) male and 27 (33.8 %) female, 28 (35 %) patients underwent past abdominal operations, 75 (93.8 %) patients suffered from vomiting, 79 (98.75 %) patients had abdominal pain, 77 (96.25 %) patients had constipation, 73 (91.25 %) patients had abdominal distension, 3 (3.75 %) patients had swelling at the site of the scar and 23 (28.75 %) patients had tenderness at the site of the scar.
• Regarding the place of the intestinal obstruction, 53 (66.25 %) patients had obstructed small intestine, 12 (15 %) patients had obstructed large intestine and 15 (18.75 %) patients had obstructed small and large intestine.
• Regarding the degree of dilatation, 10 (12.5 %) patients had mild dilatation while 70 (87.5 %) patients had marked dilatation.
• Regarding the level of obstruction, 3 (3.8 %) patients had jeujenal obstruction, 29 (36.3 %) patients had ileal obstruction, 15 (18.8 %) patients had jeujonoileal obstruction, 20 (25 %) patients had colonic obstruction and 13 (16.3 %) patients had all the intestine obstructed.
• Regarding the vascular state, 73 (91.3 %) patients had preserved blood supply while 7 (8.8 %) patients had ischemia.
• Associated pathology was reported in 14 (17.5 %) patients.
• Regarding the CT diagnosis of the studied patients, 23 (28.75 %) patients had adhesions, 2 (2.5 %) patients had undetermined cause, 1 (1.25 %) patient had abscess, 21 (26.25 %) patients had a mass, 4 (5 %) patients had MVO, 2 (2.5 %) patients had intussusception, 1 (1.25 %) patient had Meckel’s diverticulitis, 6 (7.5 %) patients had internal hernia, 12 (15 %) patients had complicated hernia, 3 (3.75 %) patients had gall stone ileus and 5 (3.75 %) patients had sigmoid volvulus.
• Regarding the site of the mass, 6 (30 %) patients had rectosigmoid mass, 1 (5 %) patient had sigmoid mass, 1 (5 %) patient had rectal mass, 1 (5 %) patient had hepatic flexure mass, 2 (10 %) patients had splenic flexure mass, 5 (25 %) patients had descending colon mass, 2 (10 %) patients had ileocecal mass and 2 (10 %) patients had transverse mass.
• Regarding the histopathology of the mass, 18 (78.26 %) were moderately differentiated adenocarcinoma, 2 (8.69 %) were poorly differentiated adenocarcinoma, 3 (13.04 %) were neuroendocrinal tumor, 1 (4.34 %) was ectopic pancreatic tissue.
• Regarding the type of management, 24 (30 %) patients underwent conservative treatment, 14 (17.5 %) patients underwent Surgical operation only while 42 (52.5 %) patients underwent abdominal laparoscopy; 10 (23.8 %) of them had total laparoscopy management, 25 (59.5 %) had laparoscopy assisted surgery and 7 (16.7 %) had laparoscopy that was converted to surgery.
• Regarding the follow up of the studied patients, 77 (96.3 %) of the patients improved while 3 (3.8 %) of the patients died.
• Regarding the diagnosis by CT, 6 (7.5 %) of the patients had incorrect diagnosis while 74 (92.5 %) of the patients had correct diagnosis.
• Regarding intestinal adhesion, final diagnosis detected 25 positive cases, CT detected 23 positive and missed 2, while final diagnosis detected 55 negative cases and CT detected the same cases. CT could discriminate intestinal adhesions with 92% sensitivity, 100% specificity, 100% PPV and 96.5% NPP.
• Regarding colorectal cancer, final diagnosis detected 20 positive cases, CT detected 19 positive case and missed 1 case, while final diagnosis detected 60 negative cases and CT detected the same cases. CT could discriminate colorectal cancer with 95% sensitivity, 100% specificity, 100% PPV and 98.4% NPP.
• Regarding small intestinal tumor, final diagnosis detected 2 positive cases, CT detected 1 positive case and missed 1 case, while final diagnosis detected 78 negative cases and CT detected the same cases. CT could discriminate small intestinal tumor with 50% sensitivity, 100% specificity, 100% PPV and 98.7% NPP.
• Regarding obstructive hernia, final diagnosis detected 12 positive cases, CT detected the same cases, while final diagnosis detected 68 negative cases and CT detected the same cases. CT could discriminate obstructive hernia with 100% sensitivity, 100% specificity, 100% PPV and 100% NPP.
• Regarding sigmoid volvulus, final diagnosis detected 5 positive cases, CT detected the same cases, while final diagnosis detected 75 negative cases and CT detected the same cases. CT could discriminate sigmoid volvulus with 100% sensitivity, 100% specificity, 100% PPV and 100% NPP.
• Regarding mesenteric vascular occlusion, final diagnosis detected 4 positive cases, CT detected the same cases, while final diagnosis detected 76 negative cases and CT detected the same cases. CT could discriminate mesenteric vascular occlusion with 100% sensitivity, 100% specificity, 100% PPV and 100% NPP.
• Regarding intussusception, final diagnosis detected 2 positive cases, CT detected the same cases, while final diagnosis detected 78 negative cases and CT detected the same cases. CT could discriminate intussusception with 100% sensitivity, 100% specificity, 100% PPV and 100% NPP.
• Regarding Meckel’s diverticulitis, final diagnosis detected 1 positive case, CT detected the same cases, while final diagnosis detected 79 negative cases and CT detected the same cases. CT could discriminate Meckel’s diverticulitis with 100% sensitivity, 100% specificity, 100% PPV and 100% NPP.
• Regarding inflammatory bowel disease, final diagnosis detected no positive case, CT detected the same cases, while final diagnosis detected 79 negative cases and CT detected the same cases. CT could discriminate inflammatory bowel disease with 0% sensitivity, 100% specificity, 0% PPV and 98.75% NPP.
• Regarding internal hernia, final diagnosis detected 5 positive case, CT detected the same cases, while final diagnosis detected 75 negative cases and CT detected 1 of them as positive case and the other 74 case as negative. CT could discriminate internal hernia with 100% sensitivity, 98.7% specificity, 83.30% PPV and 100% NPP.
Conclusion
MDCT plays an extremely important role in diagnosing various small bowel pathologies. Both obstructive and non-obstructive lesions are evaluated well by MDCT. MDCT is extremely accurate in diagnosing the level, and cause of obstruction.
Recommendations
• MDCT plays an extremely important role in diagnosing intestinal obstructions.
• Future research for assessing the role of CT in diagnosis of various etiologies of intestinal obstructions are required.
• Additional multicentric studies with larger sample size are recommended.
Limitations
• It was a single center study, and the results may differ elsewhere.
• The sample size was relatively small.
• There was no control group in the study.