Localized small bowel perforation--a radiological rarity (original) (raw)
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Small Bowel Obstruction R e s i d e nt s ' S e c t io n @BULLET Pa t t e r n of t h e M o nt h
Residents inRadiology S mall bowel obstruction remains an important cause of morbidity, accounting for up to 15% of surgical admissions for acute nontraumatic abdominal pain. Clinical evidence of complete small-bowel obstruction or complications such as strangulation necessitates emergent surgical management. Traditional medical teaching advocated early operative management of small-bowel obstruction ("Never let the sun rise or set on an obstructed abdomen.") because clinical features were often unreliable in determining whether complications were present. Radiologic imaging has assumed a paramount role in directing the management of small bowel obstruction, promoted by the widespread availability of MDCT. The key question for a clinician managing a case of suspected small bowel obstruction is how to optimally treat the patient. MDCT accurately answers this question by determining if small bowel obstruction is present, identifying the site and cause of mechanical obstruction, and detecting complications. The sensitivity and specificity of MDCT in this clinical setting is more than 95%, with high accuracy reported in distinguishing small bowel obstruction from adynamic ileus in postoperative patients. Imaging is therefore pivotal in determining whether the patient can be managed conservatively and in guiding the operative approach if surgical management is required.
A study was undertaken to compare the usefulness of plain abdominal X-rays (PABR) and small bowel enema (SBE) in evaluating cases of clinically unclear small bowel obstruction. The PABR of the patients taken just before the small bowel enema were compared to the films of the SBE. Fifty-two out of 76 were eventually operated on. The results show the gross limitations of PABR in excluding the presence of small bowel obstruction. The sensitivity and negative predictive value of SBE in identifying or excluding obstruction were 100% each, while the corresponding values of PABR were 42 and 40%. However, the margin of specificity and positive predictive values were narrow; 94 and 97 percent in SBE and 86 and 88 in PABR. SBE was also superior in identifying the cause and location of obstruction. In conclusion, due to the specificity of PABR it will remain the first line of investigations in suspected intestinal obstruction. However, its limitation in excluding the presence of obstruction cannot be overemphasized. The SBE confirms or excludes obstruction promptly and should be applied as the most accurate evaluation. How to cite this article: Makanjuola D, Khoshim M, El Bakery A, Al Damegh S. Comparative study of plain abdominal films and small bowel enema in clinically unclear cases of small bowel obstruction. Saudi J Gastroenterol 1996;2:74-9 How to cite this URL: Makanjuola D, Khoshim M, El Bakery A, Al Damegh S. Comparative study of plain abdominal films and small bowel enema in clinically unclear cases of small bowel obstruction. Saudi J Gastroenterol [serial online] 1996 [cited 2011 Jul 25];2:74-9. Available from: http://www.saudijgastro.com/text.asp?1996/2/2/74/34030
CT Evaluation of Small Bowel Obstruction
RadioGraphics, 2001
Although small bowel obstruction is a common occurrence, it is essential that this clinical condition be treated properly, that the site, level, and cause of obstruction be determined accurately, and that a tentative prognosis be formulated prior to surgery. The diagnosis of small bowel obstruction is based on a comprehensive approach that includes clinical background, patient history, and results of physical examination and laboratory tests. A variety of radiologic procedures are available to aid in the diagnosis of small bowel obstruction. Recent studies have demonstrated the superiority of CT in revealing the site, level, and cause of obstruction and in demonstrating threatening signs of bowel inviability. CT has proved useful in characterizing small bowel obstruction from extrinsic causes (adhesions, closed loop, strangulation, hernia, extrinsic masses), intrinsic causes (adenocarcinoma, Crohn disease, tuberculosis, radiation enteropathy, intramural hemorrhage, intussusception), intraluminal causes (eg, bezoars), or intestinal malrotation. Conventional radiography was the modality of choice for many years and should remain the initial imaging method in patients with suspected small bowel obstruction. However, the unique capabilities of CT in this setting make this modality an important additional diagnostic tool when specific disease management issues must be addressed.
Unusual Findings in the Small Bowel
Video Journal and Encyclopedia of GI Endoscopy, 2013
Small bowel endoscopy has now become a routine investigation. The most common methods to visualize the small bowel are balloon-assisted enteroscopy and capsule endoscopy. Currently, the most common indications for small bowel endoscopy are obscure gastrointestinal bleeding and suspected or established Crohn's disease. Common findings of small bowel endoscopy include arteriovascular malformations, erosions, ulcers, and edema in the mucosa. However, there are myriad uncommon small bowel conditions which can now be visualized endoscopically. These include vasculitis, neuroendocrine tumors, familial polyposis syndromes such as Peutz-Jeghers syndrome; ulcerative celiac disease; enteropathyassociated T-cell lymphoma; and infections such as Whipple's disease, tuberculosis, and blastomycosis. The aim of this video is to demonstrate the endoscopic characteristics of various unusual but very important small bowel diseases. This article is part of an expert video encyclopedia.
Current status of small bowel radiography
Abdominal Imaging, 1996
Background: In the past, small bowel examinations were usually ordered for the sake of ''completeness.'' As a result, small bowel radiography was performed casually and without attention to detail. This review examines pertinent clinical issues and the recent contribution of small bowel radiography to the evaluation and management of the patient with suspected small bowel disease. Recommendations for the clinical utilization of small bowel radiography are discussed. Methods: Analysis of pertinent citations addressing valid indications for, and technique of, small bowel radiography from 1980 to July 1995 through a computerized bibliographic search (Medline and Current Contents). Results: Accepted clinical indications for small bowel radiography include (1) unexplained gastrointestinal bleeding, (2) possible small bowel tumor, (3) small bowel obstruction, (4) Crohn disease, and (5) malabsorption. The current literature reflects the limitations of the conventional small bowel follow-through, various modifications to improve its clinical yield, the important contribution of enteroclysis in the workup, and subsequent management of patients with possible small bowel disease. A controversy in the radiology literature exists as to whether to use the small bowel followthrough or enteroclysis as the primary method of examining the small bowel. Conclusion: The thoughtful selection of patients by clinicians for small bowel radiography is essential to make radiologic evaluation cost effective. The incidence of disease of the small intestine is low and is associated with nonspecific symptoms. Because of the inherent dif-Correspondence to: D. D. T. Maglinte ficulty of visualizing numerous loops of an actively peristalsing bowel, a reliable imaging method is needed that not only detects small or early structural abnormality but also accurately documents normalcy. The yield of information provided by enteroclysis and its high negative predictive value suggests that it should be the primary method for small bowel examination. The ''overhead''-based conventional small bowel followthrough should be abandoned. The ''fluoroscopy''based small bowel follow-through augmented when necessary by the peroral pneumocolon or the gas-enhanced double-contrast follow-through method is an acceptable alternative when enteroclysis is not possible.
Unusual causes of small bowel obstruction and contemporary diagnostic algorithm
Journal of Medical Imaging and Radiation Oncology, 2008
Intestinal obstruction is a common clinical abnormality. In 60-80% of cases, the small bowel is affected. Although postoperative adhesions are responsible in 60% of cases, the other frequently observed causes are hernia, strangulation and tumours, such as carcinoid, lymphoma or adenocarcinoma. In this pictorial essay, we presented the radiological findings of uncommon causes of small bowel obstruction as well as the suggested diagnostic algorithm.