Performance of computed tomography and its reliability for the diagnosis of transmural gastrointestional necrosis in a setting of acute ingestion of predominantly strong acid substances in adults
Issued Date
2023-01-01
Resource Type
ISSN
15563650
eISSN
15569519
Scopus ID
2-s2.0-85151683867
Pubmed ID
37010392
Journal Title
Clinical Toxicology
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Toxicology (2023)
Suggested Citation
Kaewlai R., Noppakunsomboon N., Tongsai S., Tamrakar B., Kumthong N., Teerasamit W., Kongkaewpaisan N., Pisanuwongse A., Amornsitthiwat R., Maitriwong W., Khanutwong C., Apisarnthanarak P. Performance of computed tomography and its reliability for the diagnosis of transmural gastrointestional necrosis in a setting of acute ingestion of predominantly strong acid substances in adults. Clinical Toxicology (2023). doi:10.1080/15563650.2023.2184242 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/82847
Title
Performance of computed tomography and its reliability for the diagnosis of transmural gastrointestional necrosis in a setting of acute ingestion of predominantly strong acid substances in adults
Author's Affiliation
Other Contributor(s)
Abstract
Objectives: Computed tomography has become a critical component in evaluating adult patients with acute caustic ingestions and an alternative to endoscopy for detecting transmural gastrointestinal necrosis. This study assessed the performance and reliability of computed tomography findings of transmural gastrointestinal necrosis, given that the presence of the disease potentially signifies the need for surgery. Methods: A retrospective database search was performed to identify consecutive adult patients with acute caustic ingestions who had computed tomography with endoscopy or surgery within 72 h of admission. Eight physicians reinterpreted computed tomography in two separate rounds. Diagnostic performance utilized eight rounds of radiologists' reinterpretations against reference endoscopic or surgical grades. Intra- and interobserver agreements were calculated. Results: Seventeen patients (mean age, 45.6 years; 9 men; 46 esophageal and 34 gastric segments; 16 ingested strong acid substances) met the inclusion criteria. Eight patients (10 esophageal and 13 gastric segments) had transmural gastrointestinal necrosis. The highly differentiating findings between those with and without transmural gastrointestinal necrosis were esophageal wall thickening (100% vs. 42%, P = 0.001; 100% sensitive), gastric abnormal wall enhancement and fat stranding (100% vs. 57%, P = 0.006; 100% sensitive), and gastric absent wall enhancement (46% vs. 5%, P = 0.007; 100% specific). The intra- and interobserver percentage agreements were 47–100%, and 54–100%, which increased to 53–100%, and 60–100%, respectively, when considering only radiologists’ reinterpretations. Conclusions: In a very small sample of adults who primarily ingested acid, contrast-enhanced computed tomography performed well when interpreted by a panel of radiologists.