Double contrast small-bowel radiography in the preoperative assessment of Crohn's disease: Is it still useful?

Purpose. To evaluate the usefulness of double contrast small-bowel radiography (SBR) in the preoperative assessment of patients with Crohn's disease (CD). Methods. Thirty-nine consecutive patients who underwent surgery for CD between 2000 and 2004, preceded by a preoperative small-bowel series evaluation, were enrolled in our study. The radiologic findings were compared with the intraoperative findings. Results. Small-bowel radiography was associated with good specificity and sensitivity for the detection of stenosis. Although its main limitation was a remarkable overestimation of stenosis, the main indications for surgery were always confirmed. Sensitivity and specificity were lower for the detection of internal fistulas and the correlation was significant only for SBR performed within 3 months of the operation; however, the concordance between radiological and operative findings was greater. No correlation was observed for the detection of an abdominal mass. Conclusions. Small-bowel radiography is still reliable for evaluating stenoses and internal fistulas. However, magnetic resonance imaging or computed tomography is mandatory to evaluate an abdominal mass.