CT findings of small bowel strangulation: The importance of contrast enhancement

Katsumi Hayakawa, Masato Tanikake, Shoko Yoshida, Akira Yamamoto, Eiji Yamamoto, Taisuke Morimoto

Research output: Contribution to journalReview articlepeer-review

Abstract

The purpose of this study is to illustrate computed tomography (CT) findings suggestive of small bowel strangulation. We have performed the precontrast and postcontrast CT with single and multidetector CT scanners and evaluated the bowel wall changes and mesentery changes and correlated them with the operative findings. The direct CT findings suggestive of small bowel strangulation included high-density bowel wall on precontrast scans; lack of, or diminished contrast enhancement of the involved bowel wall; localized mesenteric fluid accumulation (mesenteric congestion); and localized pneumatosis. The indirect CT signs included C- or U-shaped loops with mesenteric vessels converging toward the obstruction site, ascites, target sign, two adjacent collapsed round loops, and whirl sign. We particularly emphasize the importance of contrast enhancement of bowel mucosa for early diagnosis to differentiate strangulation from a mechanical obstruction without bowel ischemia, and also the importance to differentiate proximal secondary gas-filled dilated small bowel loops from distal primary involved fluid-filled small bowel loops because these two types of small bowel loops are present in the single peritoneal cavity. As early recognition of small bowel strangulation may help improve the patient outcome because the involved bowel loops can be preserved without resection, it is essential to become familiar with the CT signs suggested small bowel obstruction strangulation.

Original languageEnglish (US)
Pages (from-to)3-9
Number of pages7
JournalEmergency Radiology
Volume20
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • Bowel ischemia
  • Contrast enhancement
  • Mesenteric edema
  • Small bowel obstruction
  • Small bowel strangulation

ASJC Scopus subject areas

  • Emergency Medicine
  • Radiology Nuclear Medicine and imaging

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