Clinical Relevance of the Feces Sign in Small-Bowel Obstruction Due to Adhesions Depends on Its Location

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Abstract
OBJECTIVE. The objective of our study was to evaluate if the feces sign can be used to predict successful nonoperative treatment or progression to ischemia in patients with small-bowel obstruction (SBO) due to adhesions. MATERIALS AND METHODS. For this single-center retrospective observational study involving a blinded independent review by two radiologists of 237 consecutive CT examinations of 216 patients with SBO due to adhesions (age: mean, 70.9 years; median, 74 years; interquartile range, 62–84 years), the location of the transition zone (TZ), number of TZs, and presence and location of the feces sign relative to the TZ were recorded. The reference standard for diagnosing ischemia was surgical and pathologic findings (n = 108 CT examinations) or, when treatment was nonoperative (n = 129 CT examinations), clinical outcome. Factors associated with successful nonoperative treatment and ischemia were identified by univariate and multivariate analyses. RESULTS. A feces sign was seen in 88 of 237 CT exami...

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