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European Radiology
Published in: European Radiology 4/2015

01-04-2015 | Gastrointestinal

Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

Authors: Ya-Cheng Chen, Chang-Hsien Liu, Hsian-He Hsu, Chih-Yung Yu, Hong-Hau Wang, Hsiu-Lung Fan, Ran-Chou Chen, Wei-Chou Chang

Published in: European Radiology | Issue 4/2015

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Abstract

Objective

The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO).

Methods

We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air–fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared.

Results

A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, −59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < −11.75 HU predicted phytobezoar impaction.

Conclusions

MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces.

Key Points

• MDCT examination helps to differentiate phytobezoar and small-bowel faeces.
• A higher grade of obstruction is commonly associated with phytobezoar impaction.
• Mesenteric fatty stranding and intraperitoneal fluid are frequently associated with small-bowel faeces.
• Quantitative measurement of the obstructed bowel adds the diagnostic accuracy.
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Metadata
Title
Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction
Authors
Ya-Cheng Chen
Chang-Hsien Liu
Hsian-He Hsu
Chih-Yung Yu
Hong-Hau Wang
Hsiu-Lung Fan
Ran-Chou Chen
Wei-Chou Chang
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3486-1

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