Journal of the Medical Association of Thailand Vol 92, No 12:DECEMBER 2009 0125-2208 92 12 2009 Dec Accuracy of 64 Sliced Multi-detector Computed Tomography in Diagnosis of Small Bowel Obstruction 1651 EN Sopa Pongpornsup Kullaya Tarachat Sittipong Srisajjakul Original Article The purpose of the present study was to determine the accuracy of 64 sliced multi-detectorcomputed tomography (MDCT) in the diagnosis of patients with suspected small bowel obstruction (SBO)and identify the definite cause of SBO for further investigation or treatment. A retrospective study was performed on 35 patients with suspected SBO who underwent64 sliced MDCT to establish the diagnosis and cause of SBO. The patients were enrolled from January 1, 2005to June 30, 2007. The MDCT scan of whole abdomen from patients with suspected SBO were retrospectivelyevaluated by two gastrointestinal radiologists without knowledge of the patients history determined thepresence or absence of SBO, cause, location, small-bowel feces sign, complication (sign of associated bowelstrangulation), and confident on a five-point scale. Sensitivity and specificity estimates with confidenceintervals were calculated. Weighted-kappa statistics were used to estimate agreement between readers. Twenty-five patients ultimately proved to have SBO, and ten patients had no evidence of SBO. Theoverall sensitivity, specificity, and accuracy of 64 sliced MDCT to establish the diagnosis of SBO were 96%,100%, and 97%, respectively. The final diagnosis was established either by surgery (13 patients) or by theclinical evolution (12 patients). Causes of SBO included adhesions (n = 10), metastases (n = 4), postradiativeenteropathy (n = 1), internal hernia (n = 3), ileitis (n = 2), inguinal hernia (n = 1), submucosalhemorrhage (n = 1), benign stricture secondary to chronic pancreatitis (n = 1), midgut volvulus (n = 1), andSMA syndrome (n = 1). When obstructions were classified into low and high grade obstruction, CT resultscould be used to identify correctly 100% (13 of 13) of high grade SBO and 58% (7 of 12) of low grade SBO. The64 sliced MDCT yielded one false-negative for patients with partial SBO due to adhesion band. Small-bowelfeces sign was detected in 4 of 25 patients, who were diagnosed as SBO.