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Small bowel obstruction (SBO) is a common emergency in colorectal surgicalpractice. The aim of the study was to evaluate the accuracy of computerised tomography (CT) imaging in the diagnosis of SBO and its impact on subsequent surgery.A retrospective observational study of all surgically treated patients with acute SBO over a 12-month period. Thirty-three consecutive patients (18 men, 15 women; median age 78 years, range 21-90 years) who underwentpreoperative CT scan and emergency laparotomy for SBO were included. CT diagnosis of obstruction, its site and cause were compared with intra-operative findings.CT confirmed thepresence of SBO with 81% accuracy and 96% sensitivity. Exactpreoperative CT identification of the site of obstruction was more difficult andproved possible in 16 (59%) of 27 patients whose SBO was confirmed at laparotomy. The cause of obstruction was evident in 14 (52%) patients and in the remainder it was thought to be adhesional in nature. CT had no impact on the choice of surgical access (all patients had midline laparotomy) orprocedure.CT was able to diagnose SBO with high accuracy,providing an additional indication for emergency intervention in patients in whom surgery was considered clinically necessary.