Run to the operation room!

Clinical Scenario

A 70 yo woman is brought to the ED by ambulance.

She’s suffering from vomit, lach of flatus and abdominal pain since 24 hours says the nurse. 

She’s pale, the abdomen shows a midline scar. There is diffused tenderness with rebound.

Abdomen US and X rays show abnormal distended loop of small bowel.

Ok, Ok I saw the images, there’s an occlusion says the surgeon at phone but, you know, I need a CT!

Are there CT findings that identify patients requiring a run to the operation room? 

Conclusion 

Fortunately more than half of patients who present with SBO, resolves with non operative therapy. But on the other hand, more than 50% of bowel obstructions with ischemia are misdiagnosed. 

When all 3 Zielinski's signs are present strong consideration of early operative exploration should be take into account. 

Bibliography 

MD Zielinski

Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. 

J Am Coll Surg 2011 212 1068-1076 

CS Santillan

Computed Tomography of small bowel obstrucion.

Radiol Clin N Am 2013 51 17-27

Ciro Paolillo