Bowel obstruction diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Diagnostic Study of Choice

Study of choice:

• There is no single diagnostic study of choice for the diagnosis of bowel obstruction, but bowel obstruction can be diagnosed based on plain x-ray and CT scan.
• The following result of plain x-ray is confirmatory of bowel obstruction:
  • Dilated bowel loops with air-fluid level
  • Distal collapsed bowel
  • Gasless abdomen or alternatively, "string of pearls" sign
• 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 CT scan is confirmatory of bowel obstruction:
  • Dilated bowel loops with air-fluid level
  • Distal collapsed bowel
    • Additional signs:
      • "Target sign" – indicates intussusception
      • "Whirl sign" – indicates volvulus
      • "Venous cut-off sign" - indicates thrombosis
• It should be noted that bowel obstruction may be diagnosed based on clinical presentation alone.

The comparison table for diagnostic studies of choice for bowel obstruction

	Sensitivity	Specificity
CT	93%	100%
X-ray	50%	75%

Sequence of Diagnostic Studies

• The plain 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.
• CT scan is performed when:
  • The patient is not in need of immediate intervention
  • The diagnosis is equivocal
  • To identify specific site, severity of obstruction, etiology and complications

Diagnostic Criteria

There are no established criteria for the diagnosis of bowel obstruction.

References

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