{
  "abstract": "Objectives To evaluate the diagnostic accuracy of CT in identifying small and large bowel obstruction and associated complications, including ischaemia and perforation, in adult patients.Design Systematic review and meta-analysis reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy reporting guidelines.Data sources Ovid MEDLINE and Embase were searched from 1946 to 20 February 2025.Eligibility criteria The study included randomised controlled trials, cohort studies and case–control studies evaluating the diagnostic accuracy of CT for bowel obstruction in adults (aged ≥18 years). Only studies published in English were included. Conversely, case reports, editorials, conference abstracts without full data and studies focusing exclusively on paediatric populations or animal models were excluded.Data extraction and synthesis Three reviewers independently extracted data on study characteristics, CT modality, diagnostic accuracy metrics (sensitivity, specificity and predictive values) and complications. Risk of bias was assessed using the QUADAS-2 tool. A random-effects meta-analysis was conducted. Heterogeneity was assessed using I² and Tau² statistics.Results Sixty-five studies with 9418 patients were included. The pooled sensitivity and specificity of CT for bowel obstruction were 90% (95% CI 78 to 96; I²=56%, Tau²=0.36) and 88.8% (95% CI 78.0 to 94.8; I²=65%, Tau²=0.35), respectively. For bowel ischaemia, CT showed a pooled sensitivity of 47.0% (95% CI 32.4 to 59.9; I²=0%, Tau²=0.00) and specificity of 85.3% (95% CI 77.9 to 89.5; I²=1%, Tau²=0.45). Multidetector CT (MDCT) outperformed older modalities across all endpoints. Ischaemia was present in 22.05% of all cases, with higher rates in small bowel obstruction. Perforation and mortality rates were 3.98% and 4.40%, respectively. No significant publication bias was detected, and the certainty of evidence was graded as moderate for most diagnostic accuracy outcomes.Conclusions CT, particularly MDCT, offers high diagnostic accuracy for bowel obstruction and is a critical tool for detecting serious complications such as ischaemia and perforation. However, sensitivity for ischaemia remains modest. Standardised protocols and prospective studies are needed to enhance early identification and optimise care pathways.",
  "authors": [
    {
      "affiliations": [
        "NHS Wales Health Education and Improvement Wales, Nantgarw, UK"
      ],
      "name": "Suhaib J S Ahmad"
    },
    {
      "affiliations": [
        "Inselspital Universitatsspital Bern, Bern, Switzerland"
      ],
      "name": "Iris Drvaric"
    },
    {
      "affiliations": [
        "Department of Bariatric and Metabolic Surgery, Imperial College London, London, UK"
      ],
      "name": "Ahmed R Ahmed"
    },
    {
      "affiliations": [
        "Inselspital Universitatsspital Bern, Bern, Switzerland"
      ],
      "name": "Dominik Jakob"
    },
    {
      "affiliations": [
        "Department of Diagnostic, interventional and Paediatric Radiology, Inselspital University Hospital of Bern, Bern, UK"
      ],
      "name": "Ioannis Panagiotis Kyriazidis"
    },
    {
      "affiliations": [
        "Intensive Care, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands",
        "Elisabeth-Tweesteden Hospital, Klinikum Lippe Detmold, Detmold, Germany"
      ],
      "name": "Sjaak Pouwels"
    },
    {
      "affiliations": [
        "Morriston Hospital, Swansea, UK"
      ],
      "name": "Shahab Hajibandeh"
    },
    {
      "affiliations": [
        "Swansea Bay University Health Board, Port Talbot, UK"
      ],
      "name": "Alethea Tang"
    },
    {
      "affiliations": [
        "Swansea Bay University Health Board, Port Talbot, UK"
      ],
      "name": "Peter Cripps"
    },
    {
      "affiliations": [
        "Metabolic and Bariatric Surgery, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China"
      ],
      "name": "Wah Yang"
    },
    {
      "affiliations": [
        "Department of Surgery, Whittington Hospital, London, UK",
        "University College London, London, UK"
      ],
      "name": "Chetan Parmar"
    },
    {
      "affiliations": [
        "Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"
      ],
      "name": "Mohammad Kermansaravi"
    },
    {
      "affiliations": [
        "Raigmore Hospital, Inverness, UK"
      ],
      "name": "Ahmed Abdelwahed"
    },
    {
      "affiliations": [
        "Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, UK"
      ],
      "name": "Edgar Gelber"
    },
    {
      "affiliations": [
        "Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, UK"
      ],
      "name": "Anil Lala"
    },
    {
      "affiliations": [
        "Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, UK"
      ],
      "name": "Graham Whiteley"
    },
    {
      "affiliations": [
        "Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, UK"
      ],
      "name": "Danielle Wilkinson"
    },
    {
      "affiliations": [
        "Betsi Cadwaladr University Health Board, Bangor, UK"
      ],
      "name": "Anurag Agarwal"
    },
    {
      "affiliations": [
        "Betsi Cadwaladr University Health Board, Bangor, UK"
      ],
      "name": "Aaron Pritchard"
    },
    {
      "affiliations": [
        "St James’s University Hospital, Leeds, UK"
      ],
      "name": "Miriam Khalil"
    },
    {
      "affiliations": [
        "Imperial College London, London, UK"
      ],
      "name": "David Rawaf"
    },
    {
      "affiliations": [
        "Faculty of Medicine and Healthcare Sciences, School of Medicine, University of Buckingham, Buckingham, UK"
      ],
      "name": "Ameer Khamise"
    },
    {
      "affiliations": [
        "School of Medicine, University of Buckingham, Buckingham, UK"
      ],
      "name": "Ali Waleed khalid"
    },
    {
      "affiliations": [
        "Department of Urology, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK"
      ],
      "name": "Mohamed Abdulmajed"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "Amila Cizmic"
    },
    {
      "affiliations": [
        "University and Teaching Hospital Fribourg, Fribourg, Switzerland"
      ],
      "name": "Vincent Ribordy"
    },
    {
      "affiliations": [
        "Inselspital Universitatsspital Bern, Bern, Switzerland"
      ],
      "name": "Wolf E Hautz"
    },
    {
      "affiliations": [
        "Inselspital, Universitätsspital Bern, Bern, Switzerland"
      ],
      "name": "Aristomenis Konstantinos Exadaktylos"
    }
  ],
  "title": "From obstruction to ischaemia: a systematic review and meta-analysis on the diagnostic accuracy of CT scans in identifying small and large bowel obstruction, underlying causes and predicting critical complications in adults",
  "uid": "07635ec4-b288-570b-9488-cf193ec2de22"
}