The small-bowel feces sign.

Abstract

The small-bowel feces sign has been described as a finding indicative of SBO or another severe small-bowel abnormality (ie, metabolic or infectious disease) (1–3). Bowel obstruction accounts for approximately 20% of acute abdominal surgical interventions (4). In 60%–80% of cases of intestinal obstruction, the small bowel is involved (5). SBO occurs whenever intrinsic or extrinsic blocking of the normal flow of smallbowel contents is present. SBO is associated with clinical signs of abdominal tenderness, distention, and increased high-pitched bowel sounds. However, in complete obstruction with predominantly fluidfilled bowel loops, there may be less distention and diminished sounds. Similar clinical presentations can be found in cases of paralytic ileus, intraabdominal abscess, malignant tumor, pancreatitis, peptic ulcer disease, or gastroenteritis (6). Thus, an early and accurate radiologic diagnosis of SBO is of major clinical importance (7). SBO is often difficult to diagnose on the basis of conventional radiographic findings alone (8). Additional radiologic examinations are required (6). CT scans of the abdomen can show obstruction with a sensitivity of up to 100% and provide information about the specific cause and location of the obstruction, as well, which may influence the surgical approach (7). At CT, the presence of proximal small-bowel dilatation and the identification of a transition point and collapsed distal small bowel are indicative of acute high-grade SBO, which will lead to immediate surgical intervention (6,8).