Diagnostic accuracy of computed tomography scan against surgical findings in small bowel obstruction cases

Main Article Content

Faryal Gohar
Saba Sohail
Rehana Shaikh


OBJECTIVE: To determine the diagnostic accuracy of computed tomography (CT) scan in small bowel obstruction, (SBO), utilizing operative findings as the gold standard.

METHODS: This descriptive cross-sectional study was conducted at Dr. Ruth K.M. Pfau Civil Hospital Karachi, Pakistan from September 2019 to August 2020. A comprehensive assessment, including plain and contrast-enhanced CT scans of the abdomen, was performed on 267 patients with clinically suspected acute SBO. Operative findings were compared with CT results to determine diagnostic accuracy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were evaluated, considering operative findings as the gold standard.

RESULTS: Out of 267 patients, 162 (60.7%) were males, and 105 (39.3%) were females, with a mean age of 33.03±10.58 years. The mean duration of symptoms was 12.11±4.13 days. Overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the CT scan were 92.2%, 87.8%, 87.4%, 92.4%, and 89.9%, respectively. Common CT findings included dilated small bowel loops (128 cases, 100%), the point of transition (105 cases, 82%), and bowel wall thickening (71 cases, 55.5%). Post-operative analysis revealed 118 out of 128 confirmed cases and 17 additional cases initially missed by CT. Tuberculosis emerged as the leading histopathological cause (25.9%), followed by obstructed/strangulated hernias (22.2%) and adhesions (17.7%).

CONCLUSION: This study emphasizes the superior diagnostic precision of CT scans in determining the level and cause of SBO, reflecting a high sensitivity (92.2%) and specificity (87.8%). Common CT findings, including dilated bowel loops, contribute to precise identification, guiding effective clinical management.

Article Details

How to Cite
Gohar, F., S. Sohail, and R. Shaikh. “Diagnostic Accuracy of Computed Tomography Scan Against Surgical Findings in Small Bowel Obstruction Cases”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 16, no. 1, Mar. 2024, pp. 61-6, doi:10.35845/kmuj.2024.23291.
Original Articles


Sultan A, Hassan M, Ali M. Role of multidetector computed tomography with multiplanar and curved multiplanar reformations in the detection of cause of intestinal obstruction: A tertiary care experience. Cureus 2020;12(3):e7464. https://doi.org/10.7759/cureus.7464

Afzal S, Ahmad F, Farooq F. Role of multi-detector computed tomography in the diagnosis of intestinal obstruction. Cureus 2023;15(1):e33730. https://doi.org/10.7759/cureus.33730

Ojo EO, Ihezue CH, Sule AZ, Ismaila OB, Dauda AM, Adejumo AA. Aetiology, clinical pattern and outcome of adult intestinal obstruction in JOS, north central Nigeria. Afr J Med Med Sci 2014;43(Suppl 1):29-33.

Mullan CP, Siewert B, Eisenberg RL. Small bowel obstruction. AJR Am J Roentgenol 2012;198(2):W105-17. https://doi.org/10.2214/ajr.10.4998

Aregawi AB, Alem AT, Girma A. A rare case of intestinal tuberculosis with chronic partial small bowel obstruction in a 37-year-old ethiopian man. Int Med Case Rep J 2022;15:725-33. https://doi.org/10.2147/imcrj.s388269

Nayab S, Ali SM, Jesrani A, Raza ML, Zaidi SMH. Diagnostic accuracy of CT scan in detecting intestinal obstruction keeping the histopathology findings as gold standard. Ann Abbasi Shaheed Hosp Karachi Med Dent Coll 2016;21(1):17-22.

Soressa U, Mamo A, Hiko D, Fentahun N. Prevalence, causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia. BMC Surg 2016;16(1):38. https://doi.org/10.1186/s12893-016-0150-5

Paulson EK, Thompson WM. Review of small-bowel obstruction: the diagnosis and when to worry. Radiology 2015;275(2):332-42. https://doi.org/10.1148/radiol.15131519

Memon W, Khattak YJ, Alam T, Sconfienza LM, Awais M, Anwar SSM. MDCT of small bowel obstruction: How reliable are oblique reformatted images in localizing point of transition? Gastroenterol Res Pract 2014;2014:1-7. https://doi.org/10.1155/2014/815802

Mallo RD, Salem L, Lalani T, Flum DR. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg 2005;9(5):690-4. https://doi.org/10.1016/j.gassur.2004.10.006

Nicolaou S, Kai B, Ho S, Su J, Ahamed K. Imaging of acute small-bowel obstruction. ARJ Am J Roentgenol 2005;185(4):1036-44. https://doi.org/10.2214/ajr.04.0815

Mohi JK, Kajal S, Singh T, Singh J, Kaur N. Role of imaging in evaluation of intestinal obstruction. Int J Med Res Rev 2017;5(6):593-603.

Iqbal A, Shahzad S, Gul P, Kumar B. To determine the diagnostic accuracy of curved multiplanar reformat of multidetector CT scan in visualizing zone of transition in patients with intestinal obstruction. J Liaquat Uni Med Health Sci 2017;16(1):37-40. https://doi.org/10.22442/jlumhs.171610503

Hassan M, Ali M, Shazlee MK, Bughio S, Raza F, Haroon F. Detection of transition zone in bowel obstruction via curved multiplanar reformations with multidetector computed tomography. Cureus 2019;11(3):e4233. https://doi.org/10.7759/cureus.4233

Shaikh M, Sahito AA, Azeem N, Khan A, Shaikh AH, Memon SA. Diagnostic accuracy of CT scan in detection of point of transition of small bowel obstruction. Ann Punjab Med Coll 2022;16 (1):33-6. https://doi.org/10.29054/apmc/2022.1037

Idris M, Kashif N, Idris S, Memon WA, Tanveer UH, Haider Z. Accuracy of 64-slice multidetector computed tomography scan in detecting of the point of transition of small bowel obstruction. Jpn J Radiol 2012;30(3):235-41. https://doi.org/10.1007/s11604-011-0038-3

Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M. Frequency and relevance of the "small-bowel feces" sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol 2004;183(5):1361-6. https://doi.org/10.2214/ajr.183.5.1831361

Khatib S, Tabassum S, Urooj T, Haider S, Mehmood T. Diagnostic accuracy of multi-detector ct scan in detection of ‘point of transition’ in small bowel obstruction. Pak J Radiol 2019;29(2):108-12.

Li Z, Zhang L, Liu X, Yuan F, Song B. Diagnostic utility of CT for small bowel obstruction: Systematic review and meta-analysis. PLoS One 2019;14(12): e0226740. https://doi.org/10.1371/journal.pone.0226740

Vaughan-Shaw PG, Aung M, Knight H, Williams T, Borley NR, Wheeler JMD. Systematic analysis of missed colorectal cancer cases and common pitfalls in diagnosis. Frontline Gastroenterol 2015;6(4):232-40. https://doi.org/10.1136/flgastro-2014-100513

Klang E, Eifer M, Kopylov U, Belsky V, Raskin S, Konen E, et al. Pitfalls in diagnosing colon cancer on abdominal CT. Clin Radiol 2017;72(10):858-63. https://doi.org/10.1016/j.crad.2017.06.007

Elsayed EE, Habib RM, Soltan BS. Role of multidetector computed tomography in the diagnosis of intestinal obstruction. Menoufia Med J 2018;31:1465-2. https://doi.org/10.4103/mmj.mmj_194_16