 Hello, my name is Dr. Devesh Vijay Buble. I'm from Kalinga Institute of Medical Sciences, Bhubaneshwar. My topic is diagnostic performance of contrast enhance computer tomography in intestinal obstruction with surgical correlation. So the bowel obstruction is one of the most common non-traumatic abdominal emergency encountered accounting for approximately 20% of acute abdominal conditions, with small bowel being involved in 60 to 80% of cases. Plain radiograph is the first step for making the diagnosis, but currently CT has a greater sensitivity of 94 to 100% and an accuracy of 90 to 95%. The site and cause of obstruction is valuable information for surgeons making the decision to operate. CT helps in operational planning, which has led to its inclusion in the guidelines for the management of small bowel obstruction. Intervenous contrast helps in diagnosing strangulation in identifying the specific cause of small bowel obstruction and in characterizing other pathology, such as superior mesentery artery or superior mesentery vein thrombosis, which can produce an ideas that mimics mechanical obstruction. Our aim and objectives of the study is to evaluate the diagnostic performance of CT in intestinal obstruction, the role of CT in detecting presence of complications and to correlate CT findings with intraoperative findings. Materials and methods that we have used as CT was performed using geooptima 64 slice CT scan. First, a plain CT scan of the abdomen was done followed by contrast enhance CT scan of the abdomen by intravenous administration of non-ironic advenated contrast. I promote was given at the rate of 1.5 ml per kg body weight at 1 to 1.5 cc per second. Next, series of images were taken in venous phase with scan delay of 6 to 70 seconds. In cases of suspected mesentery arterial occlusion and early arterial phase 20 to 25 seconds scan delay followed by venous phase 6 to 70 seconds scan delay was performed using IV contrast at the rate of three to four cc per second. The patient was followed up for interoperative correlation. The study was conducted in department of radio diagnosis, Kim's Patti Abumneshwar. 50 cases of intestinal obstruction chosen by simple random technique were studied in the department of our college. The inclusion criteria, we included patients with suspected intestinal obstruction who will undergo CCD abdomen followed by surgery. Exclusion criteria, patient in whom CCD abdomen cannot be performed. Pregnancy, renal failure, sensitivity to contrast medium were the criteria. Patients with adynamic obstruction and patients in whom surgical findings are not available were not included. Statistical analysis was done using collect data using SPSS 22.0 software in terms of mean and standard deviation for continuous variables and percentage for categorical variables. Cross tribulation was performed for all the variables of interest. MacNamers, Chai square test was performed to test the significance of proportions of CT with surgical findings. The sensitivity, specificity, positive negative predictive values were computed. P value less than 0.05 was considered to be statistically significant. The study was carried out in an age group ranging from 10 to 19 years. Observation result, in our study we observed that in the age group of 10 to 20, seven people had obstruction. In the age group between 21 to 30, three were diagnosed with obstruction. 31 to 40, four number of patients were diagnosed. 41 to 40 had eight numbers. 51 to 60 had 10 and 61 to 70 had 13 and 71 to 85 respectively. All of the patients came with the common symptom of pain abdomen. 37% had a symptom of vomiting. 27 had a symptom of abdominal distention and 30 had symptoms of constipation while eight people had symptoms other than the ones listed. In the, in case of etiology, stricture was seen in nine patients, nine patients, adhesion bands were seen in 16, four willers in three, abdominal tuberculosis in four, inflammatory seven, hernia five and Casinoma colon five and induced reception one respectively as the etiology of obstruction. Males had more cases of obstruction than females. On CT, free fluid was seen in 23 number of patients, transition point in 37, vascular compromise was seen in four, perforation was seen in three, free air was seen in one and lymph nodes was seen in 12 respectively. Coming to the level of obstruction, small bowel obstruction was seen in 37 number of patients while as large bowel was seen in 13 number of patients. Site of obstruction, none of the patients had during them as the site of obstruction. 11 patients had judging them as the site of obstruction. EDM and inner cylindrical junction was seen as site of obstruction in 32 number of patients. Seekum and ascending colon in three, transverse colon in four, ascending, descending colon in one, sigmoid colon in six and lectosigmoid junction and lectum in one respectively. Coming to the discussion, industry of obstruction remains one of the most common global surgical problem. Therefore, industrial obstruction has earned great attention for further research. Ethiology of industrial obstruction is highly variable from one state to another state in the same country. In our study, we found that 32% cases to be having adhesive industrial obstruction due to adhesions of pants followed by stricture, 18% and inflammatory conditions, 14%. It has been seen in the incidence of malignancy of colon causing intestinal obstruction in our studies, 10% while obstruction due to hernia is seen in five cases. Industrial obstruction due to abdominal tuberculosis was found in four cases, which amounts to 8% and three cases of vertebrates leading to intestinal obstruction. First, we call it. One case of intestinal obstruction due to intercess section caused by lipoma was found. In our study, we observed more number of cases of intestinal obstruction with increasing age. The commonest age group belonged to patients of age 61 to 70 followed by 51 to 60 years, which had 10 number of cases and 41 to 50 years. These number of patients were in the age group of 21 to 30, that is three, which amounted to 6% of the total case. The youngest patient in the study was aged 11 years and the oldest was of 80 years and the mean age was 49.6 years. The commonest clinical presenting company in our study was pain in abdomen, which was seen in all the patients followed by abdominal distinctions in 37 patients, amounted to 74%, vomiting in 27 patients and constipation in 22. And lastly, some of the patients showed weight loss and fever. Majority of the patients presented with multiple complaints, constipation was primarily complained in the patients with large world obstruction and only small percentage of patients with small world obstruction had constipation. Demographic features in our study, intestinal obstruction was observed more frequently in males as compared to females. 58% of population in our study was males and 42% was females, respectively. In the present study, 50 patients underwent CCT abdomen and after which they had surgery. All 50 patients were diagnosed with intestinal obstruction on CCT abdomen. By loan surgery, 47 patients had intestinal obstruction. CT over-estimated three patients with bowel obstruction, which on surgery proved otherwise. The overall sensory specificity, positive predictive value, negative predictive accuracy of CT was 100%, 94%, 94%, 100% and 96% respectively. The comments finding observed on CT in our study were a transition point in 37 patients followed by free fluid in 23 patients, lymph nodes in 12 patients, vascular compromise in four patients and perforation in three patients. Free air was observed in one patient. In our study, we observed a total of 50 patients with bowel obstruction on CT, of which 37 patients had small world obstruction, which amounted to 74%. And 13 had large world obstruction, which made 26% of the population. In our study, among small world obstruction only, the commonest level of obstruction was IEM and ILO secret junction with judgment obstruction seen in 11 patients. Among large world obstruction, the commonest side of obstruction was sigmoid colab. In 12% of patients, followed by cecum and ascending colon in 8% of patients. Tectosigmoid junction and rectum in 1% of patients respectively and descending colon in 1% patient. Our study has certain limitations. Our patient population was limited and a more extensive patient population could have shown other factors causing bowel obstruction. This could theoretically affect the overall accuracy of CT and evaluation of bowel obstruction. It is possible that majority of patients who presented with suspected industrial obstructions have high-grade obstruction and our data may have inadvertently been biased towards high-grade obstruction and not general population. Coming to the confusion, CT abdomen is a valuable imaging modality in the diagnosis of industrial obstruction. Early recognition and aggressive treatment may help in preventing irreversible ischemia and transmittal necrosis, along with decreasing the morbidity and mortality. Currently, CT abdomen is considered as the most important, appropriate radiological investigation in evaluation of small and large bowel obstruction. CT is also able to demonstrate the level of obstruction, diagnose common causes of bowel obstruction and to differentiate between high and low-grade obstruction. Furthermore, CTCT also helps to assess complication of obstruction such as strangulation. Thank you.