Roentgenographic appraisal of large bowel obstruction in adults

Abstract

An earlier and more accurate roentgenographic diagnosis has undoubtedly been one of the major factors in the reduced mortality in obstruction of the colon. In suspected cases of mechanical obstruction of the large bowel, scout roentgenograms of the abdomen are indicated and usually quite informative. If these do not prove to be absolutely diagnostic and bowel distention is present, a barium enema study should be performed at once. No preparation is necessary for this emergency procedure. If there is an obvious obstruction to retrograde flow of barium during fluoroscopy, a limited amount of barium should be allowed to pass proximal to the obstruction. With proper roentgenographic study, one can establish the presence and site of a mechanical large bowel obstruction, and, often, the nature of the obstructing lesion will be demonstrated. The most important points in differentiating among colonic obstructions caused by carcinoma, diverticulitis, sigmoid volvulus, cecal volvulus and intussusception are discussed and demonstrated.