Evaluation Of Small Bowel Obstruction Research Articles

Hot off the press: Going ultrasound-For small bowel obstructions.

Academic Emergency MedicineVolume 30, Issue 1 p. 62-64 HOT OFF THE PRESS Hot off the press: Going ultrasound—For small bowel obstructions Kirsty Challen MBChB PhD, Corresponding Author Kirsty Challen MBChB PhD kirsty.challen@lthtr.nhs.uk orcid.org/0000-0003-4032-5531 Lancashire Teaching Hospitals NHS Trust, Preston, UK Correspondence Kirsty Challen, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, UK. Email: kirsty.challen@lthtr.nhs.ukSearch for more papers by this authorChris Bond MD, Chris Bond MD orcid.org/0000-0002-1593-6659 University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorW. Ken Milne MD, W. Ken Milne MD University of Western Ontario, Goderich, Ontario, CanadaSearch for more papers by this author Kirsty Challen MBChB PhD, Corresponding Author Kirsty Challen MBChB PhD kirsty.challen@lthtr.nhs.uk orcid.org/0000-0003-4032-5531 Lancashire Teaching Hospitals NHS Trust, Preston, UK Correspondence Kirsty Challen, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, UK. Email: kirsty.challen@lthtr.nhs.ukSearch for more papers by this authorChris Bond MD, Chris Bond MD orcid.org/0000-0002-1593-6659 University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorW. Ken Milne MD, W. Ken Milne MD University of Western Ontario, Goderich, Ontario, CanadaSearch for more papers by this author First published: 22 November 2022 https://doi.org/10.1111/acem.14621 Discussing: Brower CH, Baugh CW, Shokoohi H, et al. Point-of-care ultrasound first for the evaluation of small bowel obstruction: national cost savings, length of stay reduction, and preventable radiation exposure. Acad Emerg Med. 2022;29:824–834. Associated podcast: https://thesgem.com/2022/07/sgem373-going-ultrasound-for-small-bowel-obstructions/ Supervising Editor: Dr. Jeffrey Kline. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume30, Issue1January 2023Pages 62-64 RelatedInformation

Appendiceal Mucinous Tumor Presenting as Recurrent Bowel Obstruction.

Appendiceal mucinous tumors are rare, with variable malignant potential, and they are usually found incidentally. Clinical symptoms are nonspecific. Rarely, appendiceal mucinous neoplasm causes bowel obstruction and makes diagnosis more difficult. We present a case of an 84-year-old female who came to our emergency department having had abdominal fullness and constipation for 5 days. Ileus, due to an affected adhesion band, was diagnosed initially, and symptoms improved gradually under conservative treatment. However, 3 months later she presented to the emergency department again with abdominal pain and distension; small bowel obstruction due to adhesion was again diagnosed. Recurrent bowel obstruction prompted emergent surgery. Operative findings showed a whitish appendiceal tumor adhering to and directly invading the adjacent ileum, with a segment of herniated small bowel wedged in between, causing the obstruction. Upon reviewing the initial computed tomography scan, the dilated tubular structure of appendiceal tumor was misrecognized as small bowel loop; there was no surrounding inflammatory sign, leading to diagnosis difficulty. Instead of a common cause of bowel obstruction, such as adhesion band, this case revealed bowel obstruction can be caused by the direct invasion of an appendiceal tumor. Awareness of this condition with careful image evaluation of small bowel obstruction is essential for diagnosis.

Point-of-care ultrasound-first for the evaluation of small bowel obstruction: National cost savings, length of stay reduction, and preventable radiation exposure.

Computed tomography (CT) has long been the gold standard in diagnosing patients with suspected small bowel obstruction (SBO). Recently, point-of-care ultrasound (POCUS) has demonstrated comparable test characteristics to CT imaging for the diagnosis of SBO. Our primary objective was to estimate the annual national cost saving impact of a POCUS-first approach for the evaluation of SBO. Our secondary objectives were to estimate the reduction in radiation exposure and emergency department (ED) length of stay (LOS). We created and ran 1000 trials of a Monte Carlo simulation. The study population included all patients presenting to the ED with abdominal pain who were diagnosed with SBO. Using this simulation, we modeled the national annual cost savings in averted advanced imaging from a POCUS-first approach for SBO. The model assumes that all patients who require surgery or have non-diagnostic POCUS exams undergo CT imaging. The model also conservatively assumes that a subset of patients with diagnostic POCUS exams undergo additional confirmatory CT imaging. We used the same Monte Carlo model to estimate the reduction in radiation exposure and total ED bed hours saved. A POCUS-first approach for diagnosing SBO was estimated to save a mean (±SD) of $30.1 million (±8.9 million) by avoiding 143,000 (±31,000) CT scans. This resulted in a national cumulative decrease of 507,000 bed hours (±268,000) in ED LOS. The reduction in radiation exposure to patients could potentially prevent 195 (±56) excess annual cancer cases and 98 (±28) excess annual cancer deaths. If adopted widely and used consistently, a POCUS-first algorithm for SBO could yield substantial national cost savings by averting advanced imaging, decreasing ED LOS, and reducing unnecessary radiation exposure in patients. Clinical decision tools are needed to better identify which patients would most benefit from CT imaging for SBO in the ED.

Small Bowel Obstruction by CT Scan

Case Report: CT is an effective tool in evaluation of small bowel obstruction. Small bowel obstruction is common cause of abdominal emergency. Diagnosis helps effective management and prevent complication. The small bowel faces sign is a finding observed in small bowel obstruction on helical CT scan. It's defined as presence of faces like material in the lumen of dilated loops of small bowel proximal to the site of obstruction this section will illustrate the small bowel faces sign with examples. Small bowel obstruction is common cause of acute abdomen. It account approximately 4% of patient with acute abdomen. Clinical signs and symptoms are not always diagnostic. Identifying the cause of obstruction is important for early management. Many other clinical condition like a dynamicileus, intra-abdominal abscess and gastroenteritis present with same clinical presentation

Small bowel obstruction and the gastrografin challenge.

The "gastrografin challenge" has been used for decades in the evaluation of small bowel obstruction (SBO). This type of study involves enteric administration of a water-soluble contrast followed by serial abdominal radiographs. While its diagnostic role is well established, its therapeutic role remains controversial. Following an algorithm for gastrografin challenge cases can help with interpretation. An understanding of the appearance of diluted contrast in the small bowel, the concentrating effect of contrast in the colon, and knowledge of surgical history and anatomy is paramount for diagnosis. In this article, we review the approach to acute SBO and the use of gastrografin along with reviewing image interpretation of cases of partial and complete SBO. Gastrografin use in adynamic ileus along with other potential future uses is also discussed.

Utilization of ultrasound for the evaluation of small bowel obstruction: A systematic review and meta-analysis

IntroductionSmall bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). While computed tomography (CT) is frequently utilized to confirm the diagnosis, this modality is expensive, exposes patients to radiation, may lead to time delays, and is not universally available. This study aimed to determine the test characteristics of ultrasound for the diagnosis of SBO. MethodsPubMed, CINAHL, Scopus, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were assessed for prospective trials evaluating the accuracy of ultrasound for the detection of SBO. Data were double extracted into a predefined worksheet and quality analysis was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. ResultsThis systematic review identified 11 studies comprising 1178 total patients. Overall, ultrasound was found to be 92.4% sensitive (95% CI 89.0% to 94.7%) and 96.6% specific (95% CI 88.4% to 99.1%) with a positive likelihood ratio of 27.5 (95% CI 7.7 to 98.4) and a negative likelihood ratio of 0.08 (95% CI 0.06 to 0.11). DiscussionThe existing literature suggests that ultrasound is a valuable tool in the diagnosis of SBO with a sensitivity and specificity comparable to that of CT. Ultrasound may save time and radiation exposure, while also allowing for serial examinations of patients to assess for resolution of the SBO. It may be particularly valuable in settings with limited or no access to CT. Future studies should include more studies in the Emergency Department setting, comparison of probe choices, and inclusion of more pediatric patients.

Evaluation of Small Bowel Obstruction of the Virgin Abdomen in the CT Era

Evaluation of Small Bowel Obstruction of the Virgin Abdomen in the CT Era

Role of 2-D reformatted images of MDCT in evaluation of small bowel obstruction: A case series

The availability of multidetector computed tomography (MDCT) scanners, coupled with imaging workstations that allow multiplanar and three-dimensional (3D) evaluation of isotropic data sets, have allowed improved depiction and characterization of small bowel obstruction (SBO). In this article, we present a series of five cases and emphasize that addition of coronal images to axial images enhance the identification of site and etiology of SBO especially in unusual cases of SBO.

Multidetector CT appearance of adhesion-induced small bowel obstructions: matted adhesions versus single adhesive bands

Adhesive small bowel obstruction (SBO) is a common cause of abdominal pain after surgery or peritonitis. The role of computed tomography (CT) in the evaluation of SBO has expanded. Diagnosis of adhesive SBO, however, remains challenging. Adhesions causing SBO are classified as either matted adhesions or single adhesive bands, and both types have different mechanisms that lead to SBO. In patients with matted adhesions, SBO results from angulation and kinking or from torsion of the intestines. In patients with adhesive bands, SBO results from compression of the intestine caused by the band itself. Recent advances in spatial resolution using multidetector CT (MDCT) have enabled detailed assessment of the configuration of the SBO site. Presented in this pictorial essay are characteristic MDCT findings regarding the mechanism of the obstruction process of adhesive SBO.

Internal hernias after abdominal surgeries: MDCT features

As less-invasive treatments for small bowel obstruction, such as laparoscopic surgery or small incision therapy, have become common, there is a growing demand for preoperative assessment of the cause and location of the small bowel obstruction. Thus, the role of computed tomography (CT) in the evaluation of small bowel obstruction is expanding. CT imaging of internal hernias (IHs) has been extensively described and is well established; however, CT imaging of IH after abdominal surgeries is not well recognized because of their anatomical complexity. The aims of this pictorial review are (1) to evaluate the causes of internal IHs in relation to previous abdominal surgery (e.g., IH associated with Roux-en-Y reconstruction, Billroth II reconstruction, peritoneal adhesive band, perineal hernia, and IH after gynecological procedures), (2) to demonstrate the spectrum of imaging findings on multidetector CT (MDCT), and (3) explain the key features for CT diagnosis of IHs related to previous surgical procedures, with emphasis on the multi-planar reformation (MPR) image. We also demonstrate the dynamic changes in the progression of mesenteric strangulation revealed by CT. Understanding the imaging appearance on MDCT can help radiologists guide therapy for patients with a small bowel obstruction after abdominal surgery.

Evaluation of Small Bowel Obstruction Using Multidetector Computed Tomography (MDCT)

Small bowel obstruction is a relatively common clinical condition and its diagnosis is based on the clinical signs, the patient’s history and the radiologic findings. For a patient with suspected small bowel obstruction, it is essential to determine the site, location and cause of obstruction for the appropriate management. Because of the poor accuracy of plain radiography, computed tomography (CT) now has an essential role to diagnose bowel obstruction. With the recent evolution of conventional CT into multidetector computed tomography (MDCT), it is possible to obtain cross sectional images with high spatial resolution and different post-processes can be done, such as obtaining the volume rendering (VR), maximum intensity projection (MIP), or multiplanar reformatted (MPR) images from the volume data. In this article, we illustrate and discuss the utility of the multiplanar images of MDCT for diagnosing the sites, causes and complications of small bowel obstruction.

Capsule Endoscopy Performed for Small Bowel Obstruction: A Tertiary-Referral Center Experience

Purpose: It is suggested that the use of capsule endoscopy (CE) in patients with known or suspected small bowel obstruction is contraindicated. We describe the experience of a tertiary referral center's use of CE for the specific indication of small bowel obstruction. Methods: From November 2003 to May 2007 at the University of North Carolina Hospitals, 54 CE studies were performed for the evaluation of small bowel obstruction in patients whom were being evaluated for operative intervention. We retrospectively reviewed the medical records and CE findings of these patients. Results: The majority of the population was female (57%) and Caucasian (77.8%). The median age (Q1, Q3) was 48.9 years (38.7, 62.0). Most (87%) of the studies were done on an outpatient basis. Approximately 1/3 of patients had inflammatory bowel disease, 68% of which had Crohn's disease. Recent (within 7 days) or ongoing obstruction was the indication for CE in 24% of patients; the remainder done for chronic or recurrent obstruction. The median (Q1, Q3) duration of obstructive symptoms prior to CE was 210 days (60, 1460). Most (75.9%) patients had a history of prior abdominal surgery, 20% had been previously treated with pelvic external beam radiation, and 20% had NSAID use documented at the time of CE. Radiography revealed obstruction in 32 patients (59%) prior to CE, with 24 patients (44%) having obstruction on abdominal CT or small bowel barium study. CE diagnosed potential obstructing lesions in 29 patients (54%), and 25 patients (46%) underwent surgery a median (Q1, Q3) of 20 days following CE (10.5, 55.5). Surgery after CE was diagnostic of an obstructing lesion in 95% of these patients. The capsule reached the cecum in 35% of patients. CE retention occurred in 10 patients (18.5%), with CE removal at surgery in 8 of these (14.8%). There were no perforations, emergent surgeries, or other complications after CE. CE findings agreed with operative assessment of the culprit obstructing lesion in 17 of the 25 patients whom underwent surgery (68%). No preoperative, clinical factors were significantly associated with odds of agreement between CE and surgical findings. Conclusion: CE is safe and effective in selected patients with known or suspected small bowel obstruction, based upon this review of a single tertiary center's experience.

Imaging diagnosis of two unusual forms of gallstone ileus

ileus caused by gallstone has become more and more common recently due to popular usage of computed tomography (CT) and magnetic resonance imaging (MRI). In the past, imaging diagnosis relied primarily on conventional radiography and contrast-enhanced fluoroscopy. 1 CT has subsequently been shown to be quite useful for this diagnosis. 2,3 Recently, MR cholangiopancreatography (MRCP) has emerged as a valuable noninvasive technique for evaluation of biliary disease. Here we described the CT, MRCP and gastroenterography findings in two patients with unusual form of gallstone ileus (GI), one is Bouveret's syndrome and the other is negative gallstone-induced ileus. Few reports about GI with angiografin and MRCP findings of Bouveret's syndrome has been published. 3-8

Bowel obstruction: comparison between multidetector-row CT axial and coronal planes

Acute obstruction of bowel is a common reason for presentation to the emergency department. Causes of obstruction are multiple (tumorous, inflammatory, postoperative, or congenital), but the clinical presentation is usually not specific. The abdominal radiographs are sometimes inconclusive, and cause of obstruction is rarely detected. Computed tomography (CT) has been shown to be useful in revealing the site and the cause of obstruction. Although radiologists are skilled in the interpretation of CT scans in the axial plane, the development of multidetector-row CT coupled with fast reconstruction hardware and software has stimulated interest in viewing abdomen in coronal plane. In the evaluation of small bowel obstruction, coronal plane serves as a useful adjunct for the identification of the point of transition from dilated to decompressed bowel. On the other hand, in the evaluation of large bowel obstruction, coronal planes could replace axial images in the evaluation of the site and cause of obstruction, although the best values of confidence level in the diagnosis are reached when interpreting axial combined with coronal images.

Magnetic Resonance Enteroclysis

MR enteroclysis (MRE) is an emerging technique for the evaluation of small intestinal diseases. Administration of an iso-osmotic water solution through a nasojejunal catheter can guarantee adequate luminal distention, and in combination with ultrafast sequences, such as single shot TSE, true FISP, HASTE and 3D FLASH, results in excellent anatomic demonstration of the small intestine. MR fluoroscopy can be performed during MRE examination to monitor the filling process and might be useful in studying low-grade stenosis or motility related disorders. MRE is a very promising technique for the detection and characterization of involved small bowel segments in patients with Crohn's disease while its diagnostic performance in disclosing lumen narrowing and extramural manifestations and complications of the disease is outstanding. Initial experience shows that MRE is very efficient in the diagnosis of small bowel tumors and can be used in the evaluation of small bowel obstruction.

Internal Hernia after Pancreas Transplantation with Enteric Drainage: An Unusual Cause of Small Bowel Obstruction

Although complications involving leaking at the enteric anastomosis site, graft thrombosis, and intraabdominal abscess formation have been well documented after pancreas transplantation, the occurrence of small bowel obstruction in this setting has received scant attention. Although uncommon, intestinal obstruction after pancreas transplantation may have atypical etiologies. In this article, we will review three unusual cases of intestinal obstruction in pancreas transplant recipients. The value of computed tomographic (CT) enteroclysis in equivocal situations in the diagnosis of the obstruction is emphasized. In this study, we reviewed the posttransplant course of all pancreas transplants performed between July 1, 2002 and June 1, 2004. We specifically focused on all patients that required reexploration for suspected small bowel obstruction at any time after transplantation. A total of 65 pancreas transplants were performed between July 1, 2002 and June 1, 2004. Pancreas graft survival was 97%, and patient survival was 98.5%. Five (7.7%) patients presented with mechanical small bowel obstruction, three of which were secondary to internal herniation of small intestine through a defect posterior to the pancreas allograft. All patients recovered well postsurgically. Small bowel obstruction is an uncommon complication after pancreas transplantation. CT enteroclysis in the evaluation of small bowel obstruction may assist the patient care decision-making process by providing information on the location and severity of the obstruction in the clinical situation where conventional abdominal CT and radiography are equivocal. Prompt detection of small bowel obstruction with early surgical intervention can minimize complications and preserve allograft function.

MR enteroclysis: technical considerations and clinical applications

Magnetic resonance enteroclysis (MRE) is an emerging technique for the evaluation of small bowel abnormalities. Adequate luminal distention, achieved by the administration of iso-osmotic water solution through a nasojejunal catheter, in combination with ultrafast sequences, such as single-shot turbo spin echo, true fast imaging with steady precession, half-Fourier acquired single-shot turbo spin echo, and 3D fast low-angle shot, results in excellent anatomic demonstration of the small bowel. Magnetic resonance fluoroscopy can be performed during MRE examination and might be useful in studying low-grade stenosis or motility-related disorders. Magnetic resonance enteroclysis is very promising in detecting the number and extent of involved small bowel segments in patients with Crohn's disease, and in disclosing lumen narrowing and extramural manifestations and complications of the disease. Initial experience shows that MRE is very efficient in the diagnosis of small bowel tumors and can be used in the evaluation of small bowel obstruction.

CT Evaluation of Small Bowel Obstruction

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.

Small bowel obstruction in the pediatric patient: CT evaluation

Little has been written about the use of computed tomography (CT) in the evaluation of small bowel obstruction (SBO) in children. The purpose of this study is to review the CT findings of SBO in a pediatric series and to increase awareness of CT as potential problem-solving tool for SBO in children. The medical, surgical, radiographic, and CT scan records of 20 consecutive children with surgically proven SBO were retrospectively reviewed. Duodenal and neonatal obstruction was excluded. CT scans were evaluated for small and large bowel caliber, bowel wall thickening, the appearance of the mesentery, extraluminal abnormalities, and the ability to detect the cause of obstruction. Causes of obstruction included adhesions (nine), small bowel intussusception (four), abscess (two), segmental volvulus (two), Crohn disease (one), focal stricture (one), and internal hernia (one). Small bowel dilatation was present in 19/20 children. Small bowel caliber transition was noted in 17/19 children. Two children with no small bowel caliber transition had a collapsed colon. The colon appeared normal in caliber in nine children, collapsed in nine, and filled with stool proximally and collapsed distally in two. Small bowel thickening was present in six children and mesenteric venous engorgement in three. Specific causes of obstruction were identified on CT in nine children (45%) and could be correctly predicted in seven of nine children with adhesions. In four children, the causes were either not evident or alternate diagnoses could be made. CT can be a useful adjunct in evaluating the presence or causes of SBO in children.

Re: Role of imaging in the evaluation of small-bowel obstruction.

Re: Role of imaging in the evaluation of small-bowel obstruction.J C LappasAudio Available | Share