The role of computed tomography with contrast and small bowel follow-through in management of small bowel obstruction

Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities

“…Keywords Small bowel obstruction´Computed tomography´Complications amining over 1,100 patients reveals that oral contrast was administered to all patients in 12 studies and to the majority of subjects in a further two [7,8,9,10,12,13,14,15,16,17,18,19,20,21,22]. The argument for its exclusion is strongest for those cases with plain film evidence of high-grade obstruction.…”

“…In these patients the potential delay incurred by having to wait for oral contrast to progress through the small bowel may be unacceptable [11]. Indeed, the delay is often fruitless as contrast will not have reached the site of obstruction [5,11] within the 2 h typically allowed prior to scanning [8,12,13,15,16,19,20]. Furthermore, the combination of retained intraluminal fluid and intravenous contrast enhancement aids determination of bowel wall thickness and detection of signs of ischaemia, both of which can be hampered by the presence of high attenuation oral contrast [10,11,21,22,23].…”

“…A strength of CT lies in its ability to assess the bowel wall, mesenteries and solid abdominal viscera. Hence small bowel contrast studies and CT are complementary, and when they are used in combination the diagnostic accuracy in SBO increases from 81 % to 93 % [8]. In an attempt to combine the diagnostic potentials of the two tests in a single examination, a technique for CT enteroclysis has been described [38].…”

“…Scanning should cover from the diaphragm to the pubic bone, so ensuring inclusion of the hernial orifices, typically using a 7-to 10-mm section thickness at a pitch of 1±1.5. Additional 5 mm sections (pitch = 1) through the transition point can aid interpretation [5,6,7,8,9,10,11].The value of oral contrast is still the subject of debate [11]. A review of the methodologies of 15 studies exAbstract Small bowel obstruction is a leading cause of acute surgical admissions for abdominal pain.…”

Contrast Radiography and Intestinal Obstruction

“…Peck et al 2 studied 55 patients having both computed tomography and small bowel follow-through studies to evaluate possible small bowel obstruction. They found that CT was significantly more sensitive (90% versus 50%) and had similar specificity (57% versus 57%) compared with small bowel follow-through.…”