The Value Of MSCT In The Diagnosis Of Strangulated Intestinal Obstruction And The Choice Of Surgical Treatment Opportunity

Objectives Through the analysis of the MSCT signs of strangulated intestinal obstruction to increase the diagnosis accuracy.The value of CT plain scan and CT enhancement in judging the location,degree and type of obstruction of intestinal obstruction was compared and analyzed.To explore the guiding role of MSCT on the timing of SO clinical operation.Methods MSCT image data of 21 patients with SO confirmed by operation and 52 patients with SI confirmed by operation were retrospectively analyzed.The parameters of sensitivity,specificity,positive predict value and negative predict value of CT signs in the two groups were compared.Compare the distribution and the diagnostic effect of CT signs in SO and SI in the patients.The accuracy of the diagnosis of the location,degree and type of intestinal obstruction by two methods of CT plain scan and CT enhancement was compared.To compare the MSCT signs of intestinal ischemia and intestinal infarction in SO cases,the diagnostic effects of different signs on intestinal ischemia and intestinal infarction were analyzed.Results Among the 21 patients of strangulated intestinal obstruction,the following MSCT signs:(1)direct signs: superior mesenteric superior mesenteric vein filling defect.(2)indirect signs: the thickening of intestinal wall;the mesenteric fat edema,exudation and effusion(cable sign);the mesenteric vascular thickening and mesenteric abnormal route(whirlpool sign);Ascites;the abnormal bowel enhancement(target sign)without weakening or strengthening;the intestinal wall and mesenteric or portal venous gas.All these CT features in study group showed significant differences from those in control group(P<0.05).The mesenteric fat edema,exudation and effusion(cable sign)sign was the typical CT feature with the highest sensitivity in strangulated intestinal obstruction(85.71%).The features such as the mesenteric vascular thickening and mesenteric abnormal route(whirlpool sign);the abnormal bowel enhancement(target sign)without weakening or strengthening;the intestinal wall and mesenteric or portal venous gas were with the highest specificity(100.0%).21 cases of strangulated intestinal obstruction in patients with more than 2 kinds of signs in 19 cases,52 cases of simple intestinal obstruction in patients with more than 2 kinds of signs and only 3 cases,there was significant difference between the two groups(P<0.005).The accuracy rate of CT scan and CT enhancement in diagnosis of intestinal obstruction were 73.97% and 76.71%.The accuracy of diagnosis of obstruction were 89.04%和 93.15%,and the accuracy of diagnosing obstruction was 86.30% and 90.41%.In the 6 indirect signs of the MSCT diagnosis of SO,the specific signs of intestinal infarction were: the mesenteric vascular thickening and mesenteric abnormal route(whirlpool sign);the abnormal bowel enhancement(target sign)without weakening or strengthening;the intestinal wall and mesenteric or portal venous gas.Conclusions The mesenteric fat edema,exudation and effusion(cable sign)sign was the typical CT feature with the highest sensitivity in strangulated intestinal obstruction.The features such as the mesenteric vascular thickening and mesenteric abnormal route(whirlpool sign);the abnormal bowel enhancement(target sign)without weakening or strengthening;the intestinal wall and mesenteric or portal venous gas were with the highest specificity.These signs suggest an intestinal infarction,which must be performed an operation immediately.On the basis of intestinal obstruction,the 6 kinds of signs if there is more than 2 signs indicate the presence of strangulation.CT plain scan and CT enhancement have no significant difference in judging the location,degree and type of obstruction of intestinal obstruction.CT scan can be used as the basis for diagnosis of SO in emergency.