Accuracy of Computed Tomography in Identifying the Etiology of Small Bowel Obstructions in Virgin Abdomens at a Tertiary Care Military Treatment Facility.

This article evaluates the diagnostic accuracy of computed tomography (CT) in identifying the causes of small bowel obstruction in a virgin abdomen (SBO-VA)—defined as SBO in patients without prior abdominal surgery—at a tertiary military treatment facility. The study found that CT reliably confirms obstruction and localizes transition points with 100% sensitivity but shows variable accuracy in determining specific etiologies, with high specificity and positive predictive value for foreign bodies, masses, and strictures, but poor sensitivity for adhesive disease, internal hernias, phytobezoars, and Meckel's diverticulum. Among patients managed nonoperatively, adhesive disease was the most commonly presumed cause based on CT findings. The findings suggest that while CT is essential for initial evaluation and guiding management decisions in SBO-VA, clinical judgment remains critical due to limitations in CT's ability to definitively identify all underlying causes.