What is the initial imaging for small bowel obstruction?

CT Findings. Multidetector CT is the single best imaging tool for suspected SBO. Multidetector CT has a sensitivity and specificity of 95% for the diagnosis of high-grade SBO and is less accurate in partial obstruction (4,6–8).

What is the first exam finding of a small intestine obstruction?

Physical examination findings include abdominal distension (more prevalent in distal obstructions), hyperactive bowel sounds (early), or hypoactive bowel sounds (late).

What is the gold standard for small bowel obstruction?

Computed tomography (CT) has long been the gold standard in diagnosing patients with suspected small bowel obstruction (SBO). Recently, point-of-care ultrasound (POCUS) has demonstrated comparable test characteristics to CT imaging for the diagnosis of SBO.

Can small bowel obstruction be seen on CT scan?

The reported sensitivity of CT scanning for detecting small-bowel obstruction is 78-100% in high-grade or complete obstruction. If the obstruction is partial or intermittent, the accuracy is low. CT can be helpful in excluding closed-loop small-bowel obstruction, according to Makar et al.

Is CT with or without contrast better for SBO?

CT with IV contrast is preferable for routine imaging of suspected SBO, in part to demonstrate whether the bowel is perfusing normally or is potentially ischemic, and in a minority of cases, to provide information about the potential etiology, such as Crohn disease and neoplasm.

CT Imaging: Small Bowel Obstruction (SBO)

Do you need oral contrast for small bowel obstruction?

Recent guidelines suggest that oral contrast agents (gastrografin, barium) are unnecessary, as they significantly delay diagnosis, falsely enhance adjacent bowel wall, and do not provide benefit over air and secreted fluids already in the bowel lumen.

What imaging modality is recommended when a bowel obstruction is suspected?

To confirm a diagnosis of intestinal obstruction, your doctor may recommend an abdominal X-ray. However, some intestinal obstructions can't be seen using standard X-rays. Computerized tomography (CT). A CT scan combines a series of X-ray images taken from different angles to produce cross-sectional images.

Can you see small bowel obstruction on ultrasound?

Ultrasound can accurately diagnose SBO, determining the presence or absence of pathology, with no significant difference from CT and limiting the need for CT scanning in the emergency department, speeding up the patient's management with expeditious admittance to hospital [11,12,29,30,31,32,33].

Can you see bowel obstruction on CT without contrast?

CT can identify small bowel obstruction and its significant time-sensitive complications, ischemia and perforation. Obstruction and perforation can be recognized without any contrast agents. Oral contrast is not needed and may hinder evaluation of ischemia.

Does an abdominal CT scan show the small intestine?

CT Scans and CT Enterography

This test allows them to view the small intestine and other areas of the abdomen and pelvis to detect tumors and to determine whether cancer has spread to nearby organs or tissue, such as the lymph nodes.

What is the criteria for small bowel obstruction?

A dilated small bowel that measures more than 3 cm is suggestive of an obstruction or ileus. An edematous bowel wall that measures more than 3 mm is indicative of an obstruction or other intestinal inflammatory cause. The noncompressibility of bowel and free fluid suggests obstruction.

What is the usual protocol for a small bowel series?

A preliminary x-ray is taken of the abdomen. Then the patient drinks two cups of barium. The technologist will be taking x-rays every fifteen minutes, for one hour, then every thirty minutes thereafter until the barium reaches the end of the small bowel.

What should I monitor for a small bowel obstruction?

Physical exam findings of small bowel obstruction often include, manifestations of hypovolemia (ie, orthostasis, decreased skin turgor, dry mucous membranes), abdominal distension, tenderness on palpation, tympany on percussion, high pitched tinkling bowel sounds, and peritoneal signs (such as guarding and rebound ...

What is the 3 6 9 rule for bowel obstruction?

It is often difficult to differentiate between normal small and large bowel, but this often becomes easier when the bowel is abnormally distended. The upper limit of normal diameter of the bowel is generally accepted as 3cm for the small bowel, 6cm for the colon and 9cm for the caecum (3/6/9 rule).

What is the focused assessment for small bowel obstruction?

Diagnosis for an SBO is determined with a combination of tests. A physical exam, abdominal X-ray, CT scan, ultrasound, and barium enemas are used to determine if the small bowel is obstructed and where exactly the blockage is. Patients are hospitalized to rest the bowel, with NPO status and IV fluids.

What is the abdominal examination finding of small bowel obstruction?

Patients with bowel obstruction usually appear distressed with a distended abdomen with or without fever. Physical examination of patients with bowel obstruction is usually remarkable for tympanic or hyperresonant abdomen, orthostatic hypotension, tachycardia, and dry mucus membranes.

Which imaging study is used to visualize the small intestine?

CT enterography is an imaging test that uses CT imagery and a contrast material to view the small intestine. The procedure allows your healthcare provider to determine what is causing your condition. He or she can also tell how well you're responding to treatment for a health issue, such as Crohn's disease.

Can MRI detect small bowel obstruction?

MRI provides rapid, highly accurate identification of small bowel obstruction and localization of the site, and assists estimation of the etiology. The use of MRI could enable more accurate and timely selection of patients for operative intervention without radiation exposure.

How is the small bowel examined?

Endoscopy. A test called an endoscopy allows the doctor to see the inside the gastrointestinal system. The person may be sedated while the doctor inserts a thin, lighted, flexible tube called an endoscope through the mouth, down the esophagus, and into the stomach and small bowel.

How long does CT of small bowel take?

How long will the test take? CT Enterography with contrast takes about 1 hour and 45 minutes. This includes 45 minutes for the test and 1 hour for drinking the barium.

What is a small bowel scan?

Magnetic resonance small bowel is an imaging test that lets your doctor see detailed pictures of your small intestine. It can help identify inflammation, bleeding, and other problems. The test uses magnets and sound to create detailed images of your organs.

What is the most common cause of small bowel obstruction?

Small bowel obstructions are usually caused by scar tissue, hernia, or cancer. In the United States, most obstructions occur as a result of prior surgeries. The bowel often forms bands of scar (called adhesions) after being handled during an operation.

What are the cardinal signs of intestinal obstruction?

The four cardinal symptoms of bowel obstruction are pain, vomiting, obstipation/absolute constipation, and distention. Obstipation, change in bowel habits, complete constipation, and abdominal distention are the predominant symptoms in LBO.

Can small bowel obstruction come and go?

Symptoms may be long-lasting or may come and go over time. Symptoms may be more severe at times, called acute episodes, and milder between these episodes. If chronic intestinal pseudo-obstruction affects parts of the digestive tract outside the intestines, it may cause additional symptoms.

What an abdominal CT scan Cannot detect?

Examples of conditions that we would not diagnose on CT scan or ultrasound include viral infections ('the stomach flu'), inflammation or ulcers in the stomach lining, inflammatory bowel disease (such as Crohn's Disease or Ulcerative Colitis), irritable bowel syndrome or maldigestion, pelvic floor dysfunction, strains ...