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
J Am Coll Surg 2011 212 1068-1076
CS Santillan
Radiol Clin N Am 2013 51 17-27
Ciro Paolillo

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