caa a22 4500 605493464 CHVBK 20210128100521.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00261-015-0477-x doi (NATIONALLICENCE)springer-10.1007/s00261-015-0477-x MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions [Elektronische Daten] [Ryan O'Malley, Mahmoud Al-Hawary, Ravi Kaza, Ashish Wasnik, Joel Platt, Isaac Francis] Small bowel obstruction (SBO) accounts for a considerable proportion of emergency room visits, inpatient admissions, and surgical interventions in the United States. Multi-detector computed tomography (MDCT) plays a key role in imaging patients presenting with acute symptoms suggestive of SBO, which helps in establishing the diagnosis, elucidating the cause of obstruction, and detecting complications, such as ischemia or frank bowel necrosis and perforation. Recently, management of patients with SBO has shifted toward a more conservative approach with supportive care and nasogastric tube decompression, as the obstruction in many cases can resolve spontaneously without the need for operative intervention. However, management decisions in SBO remain notoriously difficult, relying on a combination of clinical, laboratory, and imaging factors to help stratify patients into conservative or surgical treatment. Imaging is often an important factor assisting in the decision-making process since traditional clinical signs of vascular compromise, such as acidosis, fever, leukocytosis, and tachycardia are often unreliable in predicting the need for operative intervention. Thus, it is critically important for radiologists to identify imaging features that suggest or indicated high likelihood of bowel vascular compromise in order to help optimize management prior to the development of bowel ischemia and eventually necrosis. By excluding signs of potentially ischemic or necrotic bowel on MDCT, patients may be spared unnecessary surgery, thus decreasing postsurgical complications and averting potential increase for the risk of future SBO and repeated surgery. Conversely, if imaging features indicate potential vascular compromise of the bowel wall that may lead to bowel ischemia, urgent surgical intervention may prevent progression to bowel necrosis and subsequent perforation. Springer Science+Business Media New York, 2015 Bowel obstruction nationallicence Ischemia nationallicence Gastrointestinal nationallicence Computed tomography nationallicence O'Malley Ryan Department of Radiology, UW Medical Center Radiology/Imaging Services, 1959 NE Pacific Street, SS-202, 98195-7117, Seattle, WA, USA aut Al-Hawary Mahmoud Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut Kaza Ravi Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut Wasnik Ashish Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut Platt Joel Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut Francis Isaac Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut Abdominal Imaging Springer US; http://www.springer-ny.com 40/7(2015-10-01), 2248-2262 0942-8925 40:7<2248 2015 40 261 https://doi.org/10.1007/s00261-015-0477-x text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 review-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00261-015-0477-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- O'Malley Ryan Department of Radiology, UW Medical Center Radiology/Imaging Services, 1959 NE Pacific Street, SS-202, 98195-7117, Seattle, WA, USA aut NATIONALLICENCE 700 1- Al-Hawary Mahmoud Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Kaza Ravi Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Wasnik Ashish Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Platt Joel Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Francis Isaac Diagnostic Radiology, Abdominal Imaging Division, University Hospital, University of Michigan, 1500 E. Medical Center Dr, Room B1 D502, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 773 0- Abdominal Imaging Springer US; http://www.springer-ny.com 40/7(2015-10-01), 2248-2262 0942-8925 40:7<2248 2015 40 261