Bowel obstruction X-ray: Difference between revisions
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{{Bowel obstruction}} | {{Bowel obstruction}} | ||
{{CMG}} | {{CMG}};{{AE}}{{HM}} | ||
==Overview== | |||
An x-ray is the initial investigation performed in the diagnosis of bowel obstruction. Findings on an x-ray suggestive of bowel obstruction include dilated bowel loops with air-fluid level, distal collapsed bowel,absence of gas in the abdomen or alternatively, "string of pearls" sign indicating trapped flatus. | |||
==X Ray== | ==X Ray== | ||
*A plain x-ray is recommended as the initial investigation of choice when bowel obstruction is suspected. | |||
*The [[X-rays|x-ray]] should be performed when: | |||
**The patient is suspected of needing intervention and presents with symptoms of obvious distress, [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]], [[abdominal distension]], [[abdominal pain]] and [[constipation]]. | |||
*The following result of plain x-ray is confirmatory of bowel obstruction: | |||
**Dilated bowel loops with air-fluid level | |||
***In the supine postion, an estimate of bowel distension is made based on the width of the bowel loops | |||
***In the lateral postion, air fluid levels are seen more clearly | |||
**Distal collapsed bowel | |||
***Small bowel obstruction must cause a dilation of more than 2.5cm to be visible on x-ray | |||
**Gasless abdomen or alternatively, "string of pearls" sign | |||
***A "gasless abdomen" indicates that the bowel loop is filled with fluid with no room for gas to occupy the bowel loop | |||
***"String of pearls" sign indicates that a bowel loop is partially filled with fluid and that air bubbles are accumulating along the surface | |||
===Limitations of plain x-ray=== | |||
*The site and etiology of obstruction usually cannot be determined especially in the area between the dilated proximal and the nondilated distal loop of the small bowel. | |||
*It is also limited in distinguishing small from large bowel impactions. | |||
*X-rays are not sensitive in differentiating partial obstructions from paralytic ileus. | |||
< | ==== The comparison table for diagnostic studies of choice for bowel obstruction<ref name="pmid10394872">{{cite journal |vauthors=Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD |title=Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction |journal=Acta Radiol |volume=40 |issue=4 |pages=422–8 |year=1999 |pmid=10394872 |doi= |url=}}</ref> ==== | ||
{| | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" | | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity | |||
|- | |||
! style="background: #696969; color: #FFFFFF; text-align: center;" |CT | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |93% | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100% | |||
|- | |||
! style="background: #696969; color: #FFFFFF; text-align: center;" |X-ray | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |50% | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |75% | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
Revision as of 23:12, 6 February 2018
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Bowel obstruction Microchapters |
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Bowel obstruction X-ray On the Web |
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American Roentgen Ray Society Images of Bowel obstruction X-ray |
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Risk calculators and risk factors for Bowel obstruction X-ray |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
An x-ray is the initial investigation performed in the diagnosis of bowel obstruction. Findings on an x-ray suggestive of bowel obstruction include dilated bowel loops with air-fluid level, distal collapsed bowel,absence of gas in the abdomen or alternatively, "string of pearls" sign indicating trapped flatus.
X Ray
- A plain x-ray is recommended as the initial investigation of choice when bowel obstruction is suspected.
- The x-ray should be performed when:
- The patient is suspected of needing intervention and presents with symptoms of obvious distress, nausea, vomiting, abdominal distension, abdominal pain and constipation.
- The following result of plain x-ray is confirmatory of bowel obstruction:
- Dilated bowel loops with air-fluid level
- In the supine postion, an estimate of bowel distension is made based on the width of the bowel loops
- In the lateral postion, air fluid levels are seen more clearly
- Distal collapsed bowel
- Small bowel obstruction must cause a dilation of more than 2.5cm to be visible on x-ray
- Gasless abdomen or alternatively, "string of pearls" sign
- A "gasless abdomen" indicates that the bowel loop is filled with fluid with no room for gas to occupy the bowel loop
- "String of pearls" sign indicates that a bowel loop is partially filled with fluid and that air bubbles are accumulating along the surface
- Dilated bowel loops with air-fluid level
Limitations of plain x-ray
- The site and etiology of obstruction usually cannot be determined especially in the area between the dilated proximal and the nondilated distal loop of the small bowel.
- It is also limited in distinguishing small from large bowel impactions.
- X-rays are not sensitive in differentiating partial obstructions from paralytic ileus.
The comparison table for diagnostic studies of choice for bowel obstruction[1]
| Sensitivity | Specificity | |
|---|---|---|
| CT | 93% | 100% |
| X-ray | 50% | 75% |