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Small Bowel Obstruction: Bondoc, John Benedict V. FEU-NRMF Clinical Clerk M18

This document summarizes key information about small bowel obstruction seen on imaging. It describes the normal abdominal gas pattern and findings indicative of mechanical bowel obstruction on radiographs, including dilated loops over 3cm in diameter, varying air-fluid levels, and the string of pearls sign. CT scan is the preferred method to confirm and identify the cause of obstruction, demonstrating a transition site between dilated and collapsed bowel loops. The goal of imaging is to confirm and locate the obstruction and demonstrate its cause.

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John Benedict Bondoc
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122 views24 pages

Small Bowel Obstruction: Bondoc, John Benedict V. FEU-NRMF Clinical Clerk M18

This document summarizes key information about small bowel obstruction seen on imaging. It describes the normal abdominal gas pattern and findings indicative of mechanical bowel obstruction on radiographs, including dilated loops over 3cm in diameter, varying air-fluid levels, and the string of pearls sign. CT scan is the preferred method to confirm and identify the cause of obstruction, demonstrating a transition site between dilated and collapsed bowel loops. The goal of imaging is to confirm and locate the obstruction and demonstrate its cause.

Uploaded by

John Benedict Bondoc
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Small Bowel Obstruction

Bondoc, John Benedict V.


FEU-NRMF Clinical Clerk M18
“Acute Abdomen Series”
• Erect posterior-anterior chest radiograph
• Supine abdominal radiograph
• Erect or decubitus abdominal radiograph
Normal Abdominal Gas Pattern
• Normal Air Fluid levels
• Seen in stomach and small bowel
• Not exceed 2.5 cm in length in small
bowel
• Small bowel gas
• Appears as multiple small, random gas
collection scattered throughout the
abdomen
• Normal pattern: varies from no
intestinal gas to gas within 3-4 variable
shaped intestinal loops measuring less
than 2.5 to 3 cm in diameter
Mechanical Bowel Obstruction
• Stasis of bowel contents above focal lesion

• Causes:
• Obturation (occlusion by a mass in the lumen)
• Stenosis (due to intrinsic bowel disease)
• Compression of the lumen (by extrinsic disease)
Goal of Imaging
• Confirm the presence of obstruction
• Identify it level
• Demonstrate its cause
Radiographs
• Can confirm the presence of bowel obstruction 6 to 12 hours before
the diagnosis can usually be made by clinically
Variety of terms
• Complete obstruction – lumen is totally occluded
• Partial obstruction – some bowel contents pass through

• Simple obstruction – refers to blockage of the luminal contents


without interference of blood supply
• Strangulation obstruction – means that the blood supply to the bowel
is impaired

• Closed loop obstruction – blockage of a bowel loop segment at both


ends
Clinical
Presentation
• Crampy abdominal pain
• Abdominal distention
• Vomiting
Finding of SBO in Radiographs
1. Dilated loops of small bowel (>3cm) disproportionate to more distal
small bowel
2. Small bowel air-fluid levels that exceed 2.5 cm in width
3. Air-fluid levels at differing heights (>5mm) within the same loop –
“dynamic air fluid levels”
4. Two or more air-fluid levels
5. Small bubbles of gas trapped between folds in dilated, fluid-filled
loops producing the “string of pearls” sign
6. Stepladder sign
Slit/Stretch
Sign
• is a result of
small amounts
of air caught in
the valvulae of
fluid-filled
bowel
CT Scan
• Imaging method of choice to confirm small bowel obstruction and to
identify its cause
• Reveals the cause of obstruction in 70% - 90% of cases
• CT diagnosis: demonstration of a transition site between small bowel
loops dilated with fluid or air and collapsed bowel loops distal to the
obstruction
• Strings of Pearls sign
• Small-Bowel Feces sign
THE END

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