Diagnostic Value of the Iliac Vein Stenosis Percentage Combined With Indicators of Venous Reflux for Iliac Vein Compression Syndrome With Computed Tomography Venography.

OBJECTIVES: To identify a cutoff value of iliac vein stenosis in computed tomography venography (CTV) for assisting in the diagnosis of iliac vein compression syndrome (IVCS). Meanwhile, determining whether the inclusion of venous return and collateral imaging findings could further enhance the diagnostic performance. METHODS: We conducted a retrospective study on 264 patients suspected of IVCS who underwent both CTV and digital subtraction venography (DSV) from January 2016 to December 2020; they were assigned to either a control group (n = 101) or an IVCS group (n = 163) based on the DSV results. The narrowest anteroposterior diameter of the common iliac vein and the anteroposterior diameter of the distal end were measured to calculate the percentage of iliac vein stenosis. Receiver operating characteristic curve analysis was performed to determine the predictive accuracy of the percentage of iliac vein stenosis for IVCS and whether the inclusion of venous reflux indicators can further improve the diagnostic accuracy. RESULTS: With respect to the DSV results, the area under the curve was 0.797 ( P < 0.001). The best cutoff value was 46.67%, corresponding to a sensitivity of 83.44% and a specificity of 69.31% for predicting IVCS. Moreover, the combination diagnostic method had higher sensitivity and accuracy (94.48% vs 83.44% [ P = 0.01] and 84.85% vs 78.03% [ P = 0.04], respectively). CONCLUSIONS: The best cutoff percentage of iliac vein stenosis to diagnose IVCS was 46.67% with CTV. The sensitivity and accuracy of the combined diagnostic method were higher than those of the iliac vein stenosis ratio diagnostic method.

Clinical Analysis of the Curative Effect of a Transnasal Ileus Tube in the Treatment of Small Bowel Obstruction Caused by a Phytobezoar.

OBJECTIVE: To investigate the curative effect of a transnasal ileus tube in the treatment of small bowel obstruction caused by a phytobezoar. METHODS: Seventy-one patients with small bowel obstruction caused by a phytobezoar who underwent treatment in three provincial tertiary grade A hospitals in Fujian Province from March 2011 to February 2020 were included in this study. Patients were divided into the following two groups according to the treatment received: (1) conservative group, comprising patients who received medical conservative treatment, and (2) combined group, including patients who received combined medical conservative treatment and transnasal ileus tube placement. The clinical symptoms, changes in abdominal imaging, tube depth of the first day, reduction of pressure volume on the first day after catheterization, length of hospital stay, and nonsurgical rate were compared between the combined and conservative groups. RESULTS: There was no significant difference in age, sex, history of previous abdominal surgery and abdominal radiotherapy, symptoms at admission, duration of symptoms before admission, signs at admission, laboratory data, and obstruction position between the combined and conservative groups. There was a statistically significant difference in the nonsurgical rate (19/24 vs. 23/47, P = 0.014) between the combined and conservative groups. Logistic analysis showed that the duration of symptoms before admission, albumin level, and use of a transnasal ileus tube might be independent factors affecting the transition to surgery for patients with small bowel obstruction caused by a phytobezoar (P < 0.05). CONCLUSION: Timely conservative medical treatment with transnasal ileus tube placement can effectively improve the nonsurgical rate of small bowel obstruction caused by a phytobezoar. The duration of symptoms before admission, albumin level, and use of a transnasal ileus tube were closely related to whether patients with small bowel obstruction caused by phytobezoar were transferred to surgery.