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Use of Computed Tomography in the Diagnosis of Bowel Complications After Gynecologic Surgery

AlHilli, Mariam M. MBBCh; El-Nashar, Sherif A. MBBCh, MS; Garrett, Angelica T. MD; Weaver, Amy L. MS; Famuyide, Abimbola O. MBBS

doi: 10.1097/AOG.0000000000000014
Contents: Original Research

OBJECTIVE: To determine factors predictive of bowel complications after gynecologic surgery and establish the added utility of computed tomography (CT) in the diagnostic process.

METHODS: Patients who underwent gynecologic surgery between January 2, 2008, and December 30, 2010, who had CT scans of the abdomen, pelvis, or abdomen and pelvis within 42 days for a suspected bowel complication were identified. Logistic regression analysis was used to identify factors predictive of bowel-related complications. The diagnostic accuracy of CT was compared among patient risk groups based on clinical suspicion (pretest probability) of bowel complications.

RESULTS: Among 205 eligible patients, 38 (18.5%) patients had a bowel-related complication. Mean time from surgery to CT was 12.4 (10.1) days. Clinical characteristics were used to develop a clinical model that included unexpected drainage from the drain, wound, or stoma (adjusted odds ratio [OR] 26.3, 95% confidence interval [CI] 3.1–224.4, P=.003), coronary artery disease (OR 10.7, CI 1.4–80.9, P=.022), laparotomy (compared with minimally invasive surgery) (OR 4.4, CI 1.1–17.2, P=.032), and age older than 45 years (OR 2.4, CI 0.7–8.8, P=.18). Addition of CT to clinical evaluation increased the predictive ability of the model (area under the curve) from 0.73 to 0.99. Among 57 low-risk patients, three with confirmed bowel-related complications would have been missed if CT was not performed. Among 13 high-risk patients, CT sensitivity was 70%, and it was negative for bowel complications in three patients subsequently confirmed to have serious complications (one anastomotic leak, two bowel perforations).

CONCLUSIONS: In patients who have undergone gynecologic surgery and have a high clinical probability of a postoperative bowel-related complication, CT alone may fail to accurately identify patients with serious complications.

LEVEL OF EVIDENCE: II

In postoperative patients who have undergone gynecologic surgery with a high clinical probability of a bowel-related complication, computed tomography may fail to identify patients with serious complications accurately.

Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, and the Department of Health Sciences, Division of Biostatistics and Information, Mayo Clinic, Rochester, Minnesota.

Corresponding author: Abimbola O. Famuyide, MBBS, Mayo Clinic, 200 First Street, Rochester, MN 55905; e-mail: famuyide.abimbola@mayo.edu.

Presented at the Society of Gynecologic Investigation meeting, March 21–24, 2012, San Diego, California.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.