Dados do Trabalho

Título

Intestinal Occlusion: CT Imaging Features of Uncommon Intraluminal Etiologies

Introdução e objetivo(s)

Intestinal obstruction accounts for 15–20% of hospital admissions for acute abdominal pain in the United States and Europe, with mortality rates ranging from 2–8% in uncomplicated cases to 25% in ischemic complications. Intraluminal causes, such as bezoars, foreign bodies, and gallstone ileus, are less frequent than extraluminal ones but predominantly affect pediatric and elderly patients, as well as those with psychiatric disorders or a history of surgery. Multidetector computed tomography (CT) is the gold standard imaging modality, with sensitivity and specificity exceeding 90%, enabling the assessment of occlusion sites, transition points, and potential complications.

Objective
To describe and illustrate the CT imaging features of intraluminal mechanical intestinal occlusion through a pictorial essay, enhancing recognition in radiological practice.

Método(s)

A retrospective, observational, and descriptive case series was conducted, including patients with CT-confirmed intestinal occlusion. The analyzed cases included:

Bezoars
Foreign bodies in the digestive tract.
Gallstone ileus, with CT evidence of a bilioenteric fistula and obstructive calculus.

Cases with low-quality images or without definitive imaging confirmation were excluded. Medical records and CT studies were retrospectively reviewed, classifying findings by lesion type, location, and radiological characteristics. Images were processed using PACS, Horos, and RadiAnt DICOM Viewer and edited for the pictorial essay.

Discussão

CT enables a precise characterization of intraluminal occlusions. Bezoars appear as intraluminal masses with a characteristic mosaic pattern, often associated with proximal bowel dilation. Foreign bodies may be hyperdense (bones, metals) or present as soft tissue density, with indirect signs such as mural thickening and pneumoperitoneum. Gallstone ileus is diagnosed by identifying Rigler’s triad: pneumobilia, an impacted gallstone, and intestinal dilation. These imaging findings facilitate the differentiation of etiologies and the detection of complications such as ischemia or perforation.

Conclusões

Multidetector CT is essential for evaluating intraluminal mechanical intestinal occlusion, allowing for precise identification of specific imaging patterns and improving diagnostic accuracy. Its application enhances clinical management by enabling early detection, appropriate treatment, and reduced complication rates. The developed pictorial essay provides a key visual reference for radiological practice.

Palavras Chave

obstrução intestinal; Computed Tomography;

Arquivos