CT with clinical scoring to differentiate phytobezoar from feces in children small bowel obstruction

Abstract

Abstract Background: Identification of phytobezoar in childhood small bowel obstruction (SBO) characterized by small-bowel feces sign (SBFS) is still challenging. The aim of our study was to assess the diagnostic performance of quantitative CT analysis combined with the Acute General Emergency Surgical Severity-Small Bowel Obstruction (AGESS-SBO) scoring system in determining phytobezoar-related SBO. Methods: Sixteen phytobezoar-related SBO were regarded as phytobezoar group and the other 19 SBFS-positive SBO was regarded as control group. Demographic data, clinical presentation, and laboratory and CT findings were collected and analyzed. Each patient’s AGESS-SBO score was determined according to the individual medical record. Multivariate logistic regression analyses were used to identify significant variables associated with phytobezoar-related SBO. Diagnostic performance of key variables was assessed using receiver operating characteristic (ROC) curve analysis. Results: Compared to control group, phytobezoar group showed a significantly shorter debris maximal length (3.0 ± 0.5 cm vs. 3.5 ± 0.7 cm, P<0.05), stronger attenuation (12.6 ± 5.9 HU vs. 8.2 ± 4.0 HU, P <0.05) in CT,and higher AGESS-SBO score (4.5 [interquartile (IQR): 4–5]) vs. (2 [IQR: 1–4]). With the combination of debris attenuation (with cut-off of >9.0 HU) and AGESS-SBO score (with cut-off of >3 points), the positive predictive value (PPV) and negative predictive value (NPV) to diagnose phytobezoar-related SBO were 80 % (12/15) and 84 % (16/19), respectively. Conclusions:The diagnostic method of integrating quantitative CT analysis and the AGESS-SBO scoring system can improve the identification accuracy of phytobezoar in SBFS-positive childhood SBO.