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
Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention.
J Am Coll Surg 2011 212 1068-1076

CS Santillan
Computed Tomography of small bowel obstrucion.
Radiol Clin N Am 2013 51 17-27