RATIONALE AND OBJECTIVES: Computed tomography (CT) is limited in the assessment of partial small bowel obstruction (SBO). Enteroclysis is preferred but gives little direct information about the bowel wall, mesentery, or remote findings. Preliminary results of a combined CT enteroclysis (CT-E) methodology are reported.
METHODS: Forty-eight patients with suspected partial SBO underwent a water soluble contrast enteroclysis followed immediately by CT. Pump rates at fluoroscopy and CT were 75 to 100 cc/min unless a high-grade obstruction was encountered at fluoroscopy. Shrake's criteria for complete, high-grade or low-grade partial SBO were used.
RESULTS: The calculated dose per patient was 27 rad for CTE as opposed to 32 rad with traditional enteroclysis. Site specific sensitivity and specificity for low-grade partial SBO, were 82.1% and 87.5%. One death was encountered in a patient with diffuse abdominal metastatic disease and complete obstruction. This was caused by vomiting and aspiration secondary to tube placement alone, CT-enteroclysis having been aborted.
CONCLUSIONS: Computed tomographic enteroclysis is a diagnostic option for evaluation of low-grade partial SBOs. Pitfalls with this technique are encountered in decompressed torsions and hernias.
From the *Gastrointestinal Radiology and †Imaging Sections of the Department of Radiology, the ‡Department of Surgery, and §Diagnostic Radiology, Madigan Army Medical Center, Ft. Lewis, Tacoma, Washington.
The views expressed are those of the authors and do not necessarily reflect the views of the US Army or of the Department of Defense.
Reprint requests: LTC Gregory N. Bender, MD, Ch, Madigan Army Medical Center, ATTN: MCHJ-R, Department of Radiology, Tacoma, WA 98431-5000.
Received July 7, 1995 and accepted for publication, after revision, September 26, 1995.