The value of MSCT in evaluating the passability of bezoar by conservative treatment for bezoars-induced small bowel obstruction

• Published in: Abdominal imaging 2023-01, Vol.48 (1), p.236-243
• Main Authors: Gao, Xiaoyuan, Hua, Yitong, Meng, Hongxiu, Dong, Lijie, Zhang, Lin, Jiang, Xingyue, Chen, Liang
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bezoars; Bezoars - diagnostic imaging; Bezoars - therapy; Chi-square test; Computed tomography; Conservative Treatment - adverse effects; Evaluation; Female; Gastroenterology; Health risks; Hepatology; Hollow Organ GI; Humans; Image reconstruction; Imaging; Intestinal obstruction; Intestinal Obstruction - diagnostic imaging; Intestinal Obstruction - etiology; Intestinal Obstruction - therapy; Intestine, Small - diagnostic imaging; Intestine, Small - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Patients; Peritoneal fluid; Population studies; Radiology; Retrospective Studies; Risk analysis; Risk factors; Small intestine; Statistical analysis; Statistics; Tomography; Tomography, Spiral Computed; Young Adult
• ISSN: 2366-0058; 2366-004X; 2366-0058
• DOI: 10.1007/s00261-022-03700-4

Purpose To explore the multi-slice spiral computed tomography (MSCT) imaging characteristics of patients with bezoars-induced small bowel obstruction (BI-SBO) to evaluate the risk of conservative treatment. Materials and methods This retrospective study included 72 patients with BI-SBO who underwent whole-abdominal MSCT scan within 1 day before treatment. The patients were classified as the non-pass group and pass group depending on whether bezoar can pass after conservative treatment. The CT images were observed and measured by two radiologists. Statistical analysis was performed by using Student’s t test, Pearson’s chi-squared test, Fisher’s exact test, Logistic linear regression, and receiver operating characteristic curve (ROC). Results The study population consisted of 72 patients with a mean age of 52.2 ± 16.2 years (32 men and 40 women with an age range of 13–81 years). There were statistical differences between the two groups in the bezoar appearance, maximum HU of bezoar, thickness of intestinal wall, mesenteric haziness, mesenteric fluid, and peritoneal fluid ( P  = 0.002, 0.024, 0.017, 0.006, 0.021, and 0.030). The appearance of bezoar and mesenteric haziness is independent risk factors affecting whether bezoar can be passed by the conservative treatment. Sensitivity (41.7%) was decreased, NPV (76.3%) was not significantly changed, specificity (93.8%) and PPV (76.9%) were improved when both parameters were met to assess failure of conservative treatment. Conclusion The observation of important signs by MSCT and its reconstruction technology is of great clinical value in evaluating the passability of bezoar by conservative treatment, and which can provide radiographic basis for clinical treatment selection. Graphical abstract