GI Radiography


Case 8 :
 

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A 75 year old female with history of nausea, vomiting and abdominal pain of 2 days duration. Lab parameters were normal. Ultrasound scan was unremarkable. X-ray abdomen (erect) showed dilated small bowel loops with air-fluid levels suggestive of small bowel obstruction. A CT scan abdomen was performed.

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Imaging Findings

Plain scan of abdomen showed dilated small bowel loops. A collapsed ileal loop was noted along the right lateral peritoneal wall, which showed a twist in its distal aspect. No other abnormal finding was observed.

Laparotomy was performed; it revealed an ileal loop adherent to the lateral peritoneal wall, with volvulus. Adhesions were seen between the bowel loop and the peritoneum.

Diagnosis

Small bowel volvulus leading to small bowel obstruction.

Discussion

The most important role of Radiology in cases of suspected small bowel obstruction is to determine which patients require surgery and which neednít be operated. Sometimes conventional barium small bowel studies may be performed to determine the diagnosis. Some studies win whom studies demonstrated either a site of complete blockage or failure of barium to reach the caecum within 24 hours ultimately required surgery (1). Some studies have shown that plain films and conventional small bowel examination compare favorably with enteroclysis in determining the need for operation.

CT of the acute abdomen has revolutionized the role imaging has to play in detecting the causes of small bowel obstruction, and is today the gold standard in determining the cause of obstruction, when barium / plain radiographs are equivocal / not determinate of the diagnosis.

Contribution

Dr. Nikhil Cunha, Holy Family Hospital, Mumbai