The Value of Urgent Barium Enema and Computed Tomography in Acute Malignant Colonic Obstruction: Is Urgent Barium Enema Still Necessary?

The aim of this study was to evaluate the necessity of urgent barium enema in suspected cases of acute malignant colonic obstruction.We reviewed the medical records and images for 20 patients with suspected acute colonic obstruction. Nine patients were excluded. Computed tomography (CT) and urgent barium enema images for the remaining 11 cases were reviewed and the results were compared with the surgical findings. The rate of correct diagnosis of obstruction level was compared between CT and barium enema. The diameters of different colonic segments were analyzed on CT, and several different parameters were compared with the obstruction severity on barium enema.Both CT and barium enema correctly predicted the obstruction level in 100% of the cases. The ex tent of colonic dilatation was not significantly different between total obstruction and partial obstruction (P ＞ 0.05). The sensitivity and specificity of the continuity sign on CT to predict partial obstruction were 33.33% and 100%, respectively. The possibility of total obstruction for an obstructive lesion distal to the splenic flexure was not statistically different from that for an obstructive lesion proximal to the splenic flexure (P ＞ 0.05).Urgent barium enema is not necessary in suspected cases of acute malignant colonic obstruction, predominantly due to the advancement in both CT and surgical management of such cases.

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