Materiały źródłowe

• #1 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunctive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention.

• #2 Bowel Obstruction: Signs & Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/bowel-obstruction

  A bowel obstruction is a medical emergency that requires immediate care. […] Small bowel (intestine) obstructions are a common reason people visit the ED. […] Large bowel obstructions are uncommon in the general population, but theyre frequent among people with colon cancer. About 40% of people with colon cancer get diagnosed because bowel obstruction symptoms (from a tumor) prompted them to seek emergency care. […] As a bowel obstruction is a medical emergency, diagnosis usually happens quickly. It may happen alongside treatment, so no time is lost. Diagnosis may involve: Medical history: Your healthcare provider will ask about your medical history, including whether youve had any previous abdominal surgeries. Physical examination: Your provider will perform a physical exam to check for a swollen abdomen or masses. They may use a stethoscope to listen for bowel sounds that signal an obstruction. Blood tests: You may need a complete blood count and electrolyte analysis. A blood test checks for signs of infection. Electrolyte levels can show if you have severe dehydration. If so, youll need fluids immediately.

• #3 Small Bowel Obstruction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448079/

  Small bowel obstruction (SBO) is a common surgical emergency resulting from mechanical or functional disruption of intestinal transit. […] Diagnosis involves clinical assessment and imaging, with computed tomography being the gold standard to identify the transition point, ischemia, or perforation. […] This activity examines the pathophysiology, clinical presentation, diagnostic workup, and management strategies for SBO, emphasizing evidence-based practices and recent advances in care. […] Imaging, particularly computed tomography (CT), is pivotal in confirming the diagnosis and guiding treatment. […] The initial imaging study of choice is usually a plain abdominal radiograph (x-ray). […] A CT scan of the abdomen is considered the gold standard for diagnosing SBO. […] Radiologic evaluation is central to confirming the diagnosis of SBO and assessing its location, severity, and complications.

• #4 Intestinal obstruction – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/diagnosis-treatment/drc-20351465

  Tests and procedures used to diagnose intestinal obstruction include: […] Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam to assess your situation. The doctor may suspect intestinal obstruction if your abdomen is swollen or tender or if there’s a lump in your abdomen. He or she may listen for bowel sounds with a stethoscope. […] To confirm a diagnosis of intestinal obstruction, your doctor may recommend an abdominal X-ray. However, some intestinal obstructions can’t be seen using standard X-rays. […] A computed tomography (CT) scan combines a series of X-ray images taken from different angles to produce cross-sectional images. These images are more detailed than a standard X-ray, and are more likely to show an intestinal obstruction.

• #5 Bowel Obstruction: Signs & Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/bowel-obstruction

  A bowel obstruction is a medical emergency that requires immediate care. […] Small bowel (intestine) obstructions are a common reason people visit the ED. […] Large bowel obstructions are uncommon in the general population, but theyre frequent among people with colon cancer. About 40% of people with colon cancer get diagnosed because bowel obstruction symptoms (from a tumor) prompted them to seek emergency care. […] As a bowel obstruction is a medical emergency, diagnosis usually happens quickly. It may happen alongside treatment, so no time is lost. Diagnosis may involve: Medical history: Your healthcare provider will ask about your medical history, including whether youve had any previous abdominal surgeries. Physical examination: Your provider will perform a physical exam to check for a swollen abdomen or masses. They may use a stethoscope to listen for bowel sounds that signal an obstruction. Blood tests: You may need a complete blood count and electrolyte analysis. A blood test checks for signs of infection. Electrolyte levels can show if you have severe dehydration. If so, youll need fluids immediately.

• #6 Bowel Obstruction: Signs & Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/bowel-obstruction

  A bowel obstruction is a medical emergency that requires immediate care. […] Small bowel (intestine) obstructions are a common reason people visit the ED. […] Large bowel obstructions are uncommon in the general population, but theyre frequent among people with colon cancer. About 40% of people with colon cancer get diagnosed because bowel obstruction symptoms (from a tumor) prompted them to seek emergency care. […] As a bowel obstruction is a medical emergency, diagnosis usually happens quickly. It may happen alongside treatment, so no time is lost. Diagnosis may involve: Medical history: Your healthcare provider will ask about your medical history, including whether youve had any previous abdominal surgeries. Physical examination: Your provider will perform a physical exam to check for a swollen abdomen or masses. They may use a stethoscope to listen for bowel sounds that signal an obstruction. Blood tests: You may need a complete blood count and electrolyte analysis. A blood test checks for signs of infection. Electrolyte levels can show if you have severe dehydration. If so, youll need fluids immediately.

• #7 Bowel Obstruction: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/intestinal-obstruction

  An intestinal obstruction happens when your intestines become blocked so that digested foods and fluids buildup. […] If intestinal obstruction happens, things will build up behind the site of the blockage. […] There are many potential causes of intestinal obstruction. Often, this condition cant be prevented. Early diagnosis and treatment are crucial. An untreated intestinal obstruction can be fatal. […] How is it diagnosed? […] First, a doctor may push on your abdomen to examine it. They then listen with a stethoscope to any sounds being made. The presence of a hard lump or particular kinds of sounds, especially in a child, may help determine whether an obstruction exists. […] Other tests include: blood tests to check for: blood counts, liver and kidney function, levels of electrolytes; X-rays; CT scan; colonoscopy, a flexible tube with a light that your doctor uses to look at your large intestine; enema with contrast.

• #8 Intestinal obstruction – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/diagnosis-treatment/drc-20351465

  Tests and procedures used to diagnose intestinal obstruction include: […] Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam to assess your situation. The doctor may suspect intestinal obstruction if your abdomen is swollen or tender or if there’s a lump in your abdomen. He or she may listen for bowel sounds with a stethoscope. […] To confirm a diagnosis of intestinal obstruction, your doctor may recommend an abdominal X-ray. However, some intestinal obstructions can’t be seen using standard X-rays. […] A computed tomography (CT) scan combines a series of X-ray images taken from different angles to produce cross-sectional images. These images are more detailed than a standard X-ray, and are more likely to show an intestinal obstruction.

• #9 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunctive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention.

• #10 Bowel Obstruction Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/bowel-obstruction/diagnosis.html

  Your doctor will ask you questions about your symptoms, other digestive problems you’ve had, and any surgeries or procedures you’ve had in that area. He or she will check your belly for tenderness and bloating. […] Your doctor may do: […] An abdominal X-ray, which can find blockages in the small and large intestines. […] A CT scan of the belly, which helps your doctor see whether the blockage is partial or complete.

• #11 Bowel Obstruction: Signs & Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/bowel-obstruction

  A bowel obstruction is a medical emergency that requires immediate care. […] Small bowel (intestine) obstructions are a common reason people visit the ED. […] Large bowel obstructions are uncommon in the general population, but theyre frequent among people with colon cancer. About 40% of people with colon cancer get diagnosed because bowel obstruction symptoms (from a tumor) prompted them to seek emergency care. […] As a bowel obstruction is a medical emergency, diagnosis usually happens quickly. It may happen alongside treatment, so no time is lost. Diagnosis may involve: Medical history: Your healthcare provider will ask about your medical history, including whether youve had any previous abdominal surgeries. Physical examination: Your provider will perform a physical exam to check for a swollen abdomen or masses. They may use a stethoscope to listen for bowel sounds that signal an obstruction. Blood tests: You may need a complete blood count and electrolyte analysis. A blood test checks for signs of infection. Electrolyte levels can show if you have severe dehydration. If so, youll need fluids immediately.

• #12 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Laboratory evaluation of patients with suspected obstruction should include a complete blood count, metabolic panel, and serum lactate level. […] In most patients with SBO, abdominal radiography with supine views shows dilation of multiple loops of small bowel, with a paucity of gas in the large bowel. […] The American College of Radiology recommends computed tomography (CT) as the initial imaging modality for evaluation of intestinal obstruction in patients with high clinical suspicion. […] When these guidelines are followed, CT is sensitive for detection of high-grade obstruction and can define the cause and level of obstruction in most patients. […] Surgical consultation should be sought after diagnosis of obstruction in inpatients admitted to nonsurgical services. […] Management of acute intestinal obstruction is directed at correcting physiologic derangements, providing bowel rest and decompression, and removing the source of obstruction.

• #13 Small Bowel Obstruction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448079/

  Laboratory testing in SBO primarily assesses the patient’s overall health, identifies complications, and helps to monitor for signs of dehydration, electrolyte imbalance, or infection. […] The evaluation of SBO involves a combination of laboratory tests, radiographic imaging, and occasionally more specialized studies. […] The treatment and management of SBO require a multidisciplinary approach that prioritizes early recognition and intervention to optimize patient outcomes. […] Surgical intervention is indicated for patients with evidence of strangulation, such as fever, tachycardia, localized tenderness, leukocytosis, or acidosis. […] Surgical options depend on the underlying cause of SBO. […] Optimal management of SBO relies on collaboration among surgeons, radiologists, gastroenterologists, critical care specialists, pharmacists, and nursing teams. […] Early diagnosis and prompt management significantly improve outcomes, while delays in treatment are associated with higher morbidity and mortality rates.

• #14 Small Bowel Obstruction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448079/

  Laboratory testing in SBO primarily assesses the patient’s overall health, identifies complications, and helps to monitor for signs of dehydration, electrolyte imbalance, or infection. […] The evaluation of SBO involves a combination of laboratory tests, radiographic imaging, and occasionally more specialized studies. […] The treatment and management of SBO require a multidisciplinary approach that prioritizes early recognition and intervention to optimize patient outcomes. […] Surgical intervention is indicated for patients with evidence of strangulation, such as fever, tachycardia, localized tenderness, leukocytosis, or acidosis. […] Surgical options depend on the underlying cause of SBO. […] Optimal management of SBO relies on collaboration among surgeons, radiologists, gastroenterologists, critical care specialists, pharmacists, and nursing teams. […] Early diagnosis and prompt management significantly improve outcomes, while delays in treatment are associated with higher morbidity and mortality rates.

• #15 Bowel obstruction – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/bowel-obstruction/

  Imaging findings common to all modalities include dilatation of bowel loops proximal to the obstruction, air-fluid levels, and evidence of complications such as bowel perforation or ischemia. […] Laboratory studies provide supportive evidence to help assess the severity of the obstruction. […] Leukocytosis, metabolic acidosis, and elevated serum lactate in a patient with suspected bowel obstruction are suggestive of bowel ischemia.

• #16 Intestinal Obstruction – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intestinal-obstruction

  Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. […] Diagnosis is clinical and confirmed by abdominal radiographs. […] Mechanical obstruction is divided into obstruction of the small bowel (including the duodenum) and obstruction of the large bowel. […] Approximately 85% of partial small-bowel obstructions resolve with nonoperative treatment, whereas most complete small-bowel obstructions require surgery. […] Symptoms include cramping pain, vomiting, obstipation, and lack of flatus. […] In simple mechanical obstruction, blockage occurs without vascular compromise. […] Elevated white blood cells and acidosis may indicate that strangulation has already occurred, but these signs may be absent if the venous outflow from the strangulated loop of bowel is decreased.

• #17 Bowel obstruction | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/bowel-obstruction?lang=us

  Bowel obstructions are common and account for 20% of admissions with „surgical abdomens”. Radiology is important in confirming the diagnosis and identifying the underlying cause. […] Imaging plays an important role in both diagnosing bowel obstruction as well as helping determine the choice and timing of appropriate management. The main aims of imaging in cases of suspected bowel obstruction are: differentiate true mechanical obstruction from ileus or constipation, localize the site of obstruction, identify an underlying cause, assess for complications (e.g. ischemia or perforation), assess the viability of bowel segments involved. […] Once intestinal obstruction is confirmed imaging findings can guide the timing of any planned surgical intervention. In cases where there are signs of ischemia (i.e. strangulated bowel obstruction), emergency surgery may be needed to salvage bowel.

• #18 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The initial evaluation of patients with clinical signs and symptoms of intestinal obstruction should include plain upright abdominal radiography. Radiography can quickly determine if intestinal perforation has occurred; free air can be seen above the liver in upright films or left lateral decubitus films. Radiography accurately diagnoses intestinal obstruction in approximately 60 percent of cases, and its positive predictive value approaches 80 percent in patients with high-grade intestinal obstruction. […] CT is appropriate for further evaluation of patients with suspected intestinal obstruction in whom clinical examination and radiography do not yield a definitive diagnosis. CT is sensitive for detection of high-grade obstruction (up to 90 percent in some series), and has the additional benefit of defining the cause and level of obstruction in most patients.

• #19 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The initial evaluation of patients with clinical signs and symptoms of intestinal obstruction should include plain upright abdominal radiography. Radiography can quickly determine if intestinal perforation has occurred; free air can be seen above the liver in upright films or left lateral decubitus films. Radiography accurately diagnoses intestinal obstruction in approximately 60 percent of cases, and its positive predictive value approaches 80 percent in patients with high-grade intestinal obstruction. […] CT is appropriate for further evaluation of patients with suspected intestinal obstruction in whom clinical examination and radiography do not yield a definitive diagnosis. CT is sensitive for detection of high-grade obstruction (up to 90 percent in some series), and has the additional benefit of defining the cause and level of obstruction in most patients.

• #20 Small-Bowel Obstruction Workup: Laboratory Studies, Plain Radiography, Enteroclysis and CT Enterography

  https://emedicine.medscape.com/article/774140-workup

  If the diagnosis is unclear, admission and observation are warranted to detect early obstructions. Essential laboratory tests are needed, including the following: […] Obtain plain radiographs first for patients in whom small-bowel obstruction (SBO) is suspected. At least 2 views, supine or flat and upright, are required. Plain radiographs are diagnostically more accurate in cases of simple obstruction. However, diagnostic failure rates of as much as 30% have been reported. […] Enteroclysis is valuable in detecting the presence of obstruction and in differentiating partial from complete blockages. This study is useful when plain radiographic findings are normal in the presence of clinical signs of small-bowel obstruction (SBO) or when plain radiographic findings are nonspecific. […] CT scanning is useful in making an early diagnosis of strangulated obstruction and in delineating the myriad other causes of acute abdominal pain, particularly when clinical and radiographic findings are inconclusive. […] The accuracy of MRI almost approaches that of CT scanning for the detection of obstructions. […] Ultrasonography is less costly and invasive than CT scanning and may reliably exclude SBO in as many as 89% of patients; specificity is reportedly 100%.

• #21 Bowel obstruction – Wikipedia

  https://en.wikipedia.org/wiki/Bowel_obstruction

  Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. The diagnosis may be made on plain X-rays; however, CT scan is more accurate. Ultrasound or MRI may help in the diagnosis of children or pregnant women. […] The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning, and ultrasound. If a mass is identified, biopsy may determine the nature of the mass. […] Radiological signs of bowel obstruction include bowel distension (small bowel loops dilated 3 cm) and the presence of multiple (more than 2) air-fluid levels on supine and erect abdominal radiographs. […] Contrast enema or small bowel series or CT scan can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.

• #22 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Laboratory evaluation of patients with suspected obstruction should include a complete blood count, metabolic panel, and serum lactate level. […] In most patients with SBO, abdominal radiography with supine views shows dilation of multiple loops of small bowel, with a paucity of gas in the large bowel. […] The American College of Radiology recommends computed tomography (CT) as the initial imaging modality for evaluation of intestinal obstruction in patients with high clinical suspicion. […] When these guidelines are followed, CT is sensitive for detection of high-grade obstruction and can define the cause and level of obstruction in most patients. […] Surgical consultation should be sought after diagnosis of obstruction in inpatients admitted to nonsurgical services. […] Management of acute intestinal obstruction is directed at correcting physiologic derangements, providing bowel rest and decompression, and removing the source of obstruction.

• #23 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The initial evaluation of patients with clinical signs and symptoms of intestinal obstruction should include plain upright abdominal radiography. Radiography can quickly determine if intestinal perforation has occurred; free air can be seen above the liver in upright films or left lateral decubitus films. Radiography accurately diagnoses intestinal obstruction in approximately 60 percent of cases, and its positive predictive value approaches 80 percent in patients with high-grade intestinal obstruction. […] CT is appropriate for further evaluation of patients with suspected intestinal obstruction in whom clinical examination and radiography do not yield a definitive diagnosis. CT is sensitive for detection of high-grade obstruction (up to 90 percent in some series), and has the additional benefit of defining the cause and level of obstruction in most patients.

• #24 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The initial evaluation of patients with clinical signs and symptoms of intestinal obstruction should include plain upright abdominal radiography. Radiography can quickly determine if intestinal perforation has occurred; free air can be seen above the liver in upright films or left lateral decubitus films. Radiography accurately diagnoses intestinal obstruction in approximately 60 percent of cases, and its positive predictive value approaches 80 percent in patients with high-grade intestinal obstruction. […] CT is appropriate for further evaluation of patients with suspected intestinal obstruction in whom clinical examination and radiography do not yield a definitive diagnosis. CT is sensitive for detection of high-grade obstruction (up to 90 percent in some series), and has the additional benefit of defining the cause and level of obstruction in most patients.

• #25 Intestinal Obstruction and Ileus | Doctor

  https://patient.info/doctor/intestinal-obstruction-and-ileus

  Of all patients admitted to hospital with intestinal obstruction, most have small intestinal obstruction. 10-18% of colorectal malignancies present with obstruction. […] The typical clinical symptoms associated with obstruction include nausea, vomiting, dysphagia, abdominal pain and failure to pass bowel movements. Clinical signs include abdominal distention, tympany due to an air-filled stomach and high-pitched bowel sounds. […] Fluid charts are required to monitor intake and output, especially as an intravenous infusion is almost certainly required, a nasogastric tube may be passed and oliguria is an important sign of early dehydration. […] Plain abdominal X-ray can still be an important investigation: Sensitivity is 50-66% in small bowel obstruction and higher in large bowel obstruction.

• #26 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Intestinal obstruction accounts for approximately 15 percent of all emergency department visits for acute abdominal pain. Complications of intestinal obstruction include bowel ischemia and perforation. Morbidity and mortality associated with intestinal obstruction have declined since the advent of more sophisticated diagnostic tests, but the condition remains a challenging surgical diagnosis. […] A suggested approach to the patient with suspected small bowel obstruction is shown in Figure 1. […] Abdominal radiography is an effective initial examination in patients with suspected intestinal obstruction. Radiography has greater sensitivity in high-grade obstruction than in partial obstruction. Computed tomography is warranted when radiography indicates high-grade intestinal obstruction or is inconclusive. Computed tomography can reliably determine the cause of obstruction, and whether serious complications are present, in most patients with high-grade obstructions.

• #27 Bowel obstruction – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/bowel-obstruction/

  Bowel obstruction typically manifests with nausea, vomiting, abdominal pain, abdominal distention, and constipation or obstipation. […] A diagnosis of bowel obstruction should be confirmed on imaging (e.g., CT abdomen and pelvis). […] Imaging is required to confirm mechanical bowel obstruction, identify the site and assess the severity of the obstruction, identify complications and the underlying etiology of the obstruction, and guide treatment planning. […] Bowel obstruction requires a swift diagnostic workup to establish if emergency surgery is required. […] Initial imaging modality depends on the type of bowel obstruction and hemodynamic stability of the patient. […] CT abdomen and pelvis is the gold standard for diagnosing bowel obstruction. […] In acute bowel obstruction, a CT scan is more accurate than an x-ray in the identification of the site of obstruction, complications, and underlying etiology, and, therefore, influences patient management to a greater extent.

• #28 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause. […] Imaging with abdominal radiography or computed tomography can confirm the diagnosis and assist in decision making for therapeutic planning. […] The decision to pursue nonoperative management or surgical intervention must be carefully determined by experienced clinicians. […] Abdominal radiography is an appropriate initial examination in patients with suspected intestinal obstruction. […] CT can reliably determine the cause of obstruction and associated complications. […] Admission to or consultation with a surgical service should occur upon diagnosis of intestinal obstruction. […] Surgical exploration is recommended for most patients in whom three to five days of nonoperative management is ineffective, or who clinically deteriorate at any point during hospitalization.

• #29 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Laboratory evaluation of patients with suspected obstruction should include a complete blood count, metabolic panel, and serum lactate level. […] In most patients with SBO, abdominal radiography with supine views shows dilation of multiple loops of small bowel, with a paucity of gas in the large bowel. […] The American College of Radiology recommends computed tomography (CT) as the initial imaging modality for evaluation of intestinal obstruction in patients with high clinical suspicion. […] When these guidelines are followed, CT is sensitive for detection of high-grade obstruction and can define the cause and level of obstruction in most patients. […] Surgical consultation should be sought after diagnosis of obstruction in inpatients admitted to nonsurgical services. […] Management of acute intestinal obstruction is directed at correcting physiologic derangements, providing bowel rest and decompression, and removing the source of obstruction.

• #30 Intestinal obstruction – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/diagnosis-treatment/drc-20351465

  Tests and procedures used to diagnose intestinal obstruction include: […] Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam to assess your situation. The doctor may suspect intestinal obstruction if your abdomen is swollen or tender or if there’s a lump in your abdomen. He or she may listen for bowel sounds with a stethoscope. […] To confirm a diagnosis of intestinal obstruction, your doctor may recommend an abdominal X-ray. However, some intestinal obstructions can’t be seen using standard X-rays. […] A computed tomography (CT) scan combines a series of X-ray images taken from different angles to produce cross-sectional images. These images are more detailed than a standard X-ray, and are more likely to show an intestinal obstruction.

• #31 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Intestinal obstruction accounts for approximately 15 percent of all emergency department visits for acute abdominal pain. Complications of intestinal obstruction include bowel ischemia and perforation. Morbidity and mortality associated with intestinal obstruction have declined since the advent of more sophisticated diagnostic tests, but the condition remains a challenging surgical diagnosis. […] A suggested approach to the patient with suspected small bowel obstruction is shown in Figure 1. […] Abdominal radiography is an effective initial examination in patients with suspected intestinal obstruction. Radiography has greater sensitivity in high-grade obstruction than in partial obstruction. Computed tomography is warranted when radiography indicates high-grade intestinal obstruction or is inconclusive. Computed tomography can reliably determine the cause of obstruction, and whether serious complications are present, in most patients with high-grade obstructions.

• #32 Small-Bowel Obstruction Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/374962-overview

  In small-bowel obstruction imaging, certain radiologic investigations can be used to confirm the diagnosis and severity of the obstruction, but not its etiology. Other imaging modalities are aimed at determining the cause of obstruction. […] Conventional plain radiography is the investigation of choice for patients with suspected small-bowel obstruction. This study should always be performed first. […] The unique capabilities of CT scanning make it an important diagnostic tool when a specific clinical answer is sought. Studies have shown the superiority of CT scanning in revealing not only the site of the obstruction but also its cause. CT scans may demonstrate signs of ischemia as well. […] First-line imaging in patients with abdominal pain is an acute abdominal x-ray series. Signs of bowel ischemia such as pneumatosis, portal venous gas, or pneumoperitoneum should prompt urgent surgical evaluation.

• #33 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Intestinal obstruction accounts for approximately 15 percent of all emergency department visits for acute abdominal pain. Complications of intestinal obstruction include bowel ischemia and perforation. Morbidity and mortality associated with intestinal obstruction have declined since the advent of more sophisticated diagnostic tests, but the condition remains a challenging surgical diagnosis. […] A suggested approach to the patient with suspected small bowel obstruction is shown in Figure 1. […] Abdominal radiography is an effective initial examination in patients with suspected intestinal obstruction. Radiography has greater sensitivity in high-grade obstruction than in partial obstruction. Computed tomography is warranted when radiography indicates high-grade intestinal obstruction or is inconclusive. Computed tomography can reliably determine the cause of obstruction, and whether serious complications are present, in most patients with high-grade obstructions.

• #34 Small-Bowel Obstruction, Evaluation and Management of

  https://www.east.org/education-resources/practice-management-guidelines/details/smallbowel-obstruction-evaluation-and-management-of

  CT scan of abdomen and pelvis should be considered in all patients with SBO because it can provide incremental information over plain films in differentiating grade, severity, and etiology of SBOs that may lead to changes in management. Level 1. […] Water-soluble contrast study should be considered in patients who fail to improve after 48 hours of nonoperative management because a normal contrast study can rule out operative SBO. Level 2. […] CT findings consistent with bowel ischemia should suggest a low threshold for operative intervention. Level 2. […] CT scans have been shown in Class II and III studies to be superior to plain film radiography in the overall diagnosis of SBO. […] CT scans can determine not only the level of obstruction (93%) but also the cause (8091%) in most patients.

• #35 Small-Bowel Obstruction, Evaluation and Management of

  https://www.east.org/education-resources/practice-management-guidelines/details/smallbowel-obstruction-evaluation-and-management-of

  CT findings suggestive of ischemia include reduced bowel wall enhancement; wall thickening; mesenteric venous congestion; mesenteric fluid; unusual course of the mesenteric vasculature; and ascites. […] Water-soluble contrast studies can accurately predict the need for surgery and reduce the need for operation and shorten hospital stay. […] Early operative management should be pursued in patients with suspected bowel strangulation because this is associated with an increased morbidity and mortality. […] The initial management of patients with complete SBO remains controversial. […] Patients without clinical or radiologic signs and symptoms of bowel ischemia can safely undergo initial nonoperative management. […] Nonoperative management is overall successful in 65% to 80% of patients, especially in the setting of partial SBO and early postoperative period SBO.

• #36 Small-Bowel Obstruction Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/374962-overview

  Stable patients should also undergo CT of the abdomen and pelvis with IV contrast. […] A transition zone is required for the diagnosis of small-bowel obstruction. […] CT of the abdomen and pelvis with IV contrast is usually appropriate for the initial imaging of a suspected small-bowel obstruction with an acute presentation. […] CT of the abdomen and pelvis with IV contrast or CT enterography is usually appropriate for the imaging of a suspected intermittent or low-grade small-bowel obstruction with an indolent presentation. […] Atri et al studied 99 adult patients who underwent 105 nonenhanced CTs and enhanced CTs and found that the 2 procedures had comparable accuracy in diagnosing mechanical small-bowel obstruction. […] O’Daly et al conducted a retrospective review of 88 patients who had acute adhesional small-bowel obstruction and underwent CT, and 58 (66%) were managed conservatively and 30 (34%) underwent surgery.

• #37 Small-Bowel Obstruction Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/374962-overview

  Stable patients should also undergo CT of the abdomen and pelvis with IV contrast. […] A transition zone is required for the diagnosis of small-bowel obstruction. […] CT of the abdomen and pelvis with IV contrast is usually appropriate for the initial imaging of a suspected small-bowel obstruction with an acute presentation. […] CT of the abdomen and pelvis with IV contrast or CT enterography is usually appropriate for the imaging of a suspected intermittent or low-grade small-bowel obstruction with an indolent presentation. […] Atri et al studied 99 adult patients who underwent 105 nonenhanced CTs and enhanced CTs and found that the 2 procedures had comparable accuracy in diagnosing mechanical small-bowel obstruction. […] O’Daly et al conducted a retrospective review of 88 patients who had acute adhesional small-bowel obstruction and underwent CT, and 58 (66%) were managed conservatively and 30 (34%) underwent surgery.

• #38 Bowel obstruction – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/bowel-obstruction/

  Bowel obstruction typically manifests with nausea, vomiting, abdominal pain, abdominal distention, and constipation or obstipation. […] A diagnosis of bowel obstruction should be confirmed on imaging (e.g., CT abdomen and pelvis). […] Imaging is required to confirm mechanical bowel obstruction, identify the site and assess the severity of the obstruction, identify complications and the underlying etiology of the obstruction, and guide treatment planning. […] Bowel obstruction requires a swift diagnostic workup to establish if emergency surgery is required. […] Initial imaging modality depends on the type of bowel obstruction and hemodynamic stability of the patient. […] CT abdomen and pelvis is the gold standard for diagnosing bowel obstruction. […] In acute bowel obstruction, a CT scan is more accurate than an x-ray in the identification of the site of obstruction, complications, and underlying etiology, and, therefore, influences patient management to a greater extent.

• #39 Small bowel obstruction: Diagnosis by ultrasonography

  https://www.aliem.com/small-bowel-obstruction-diagnosis-ultrasonography/

  Although highly accurate, both the CT and the MRI have the distinct disadvantages of not being able to performed at the bedside, as well as being time consuming, more costly, and in the case of CT, carrying the side effects of radiation and possible contrast reactions. Ultrasound is a bedside testing modality that has recently arisen as a viable alternative. […] Ultrasound has emerged as a possible adjunct in the accurate and timely diagnosis of SBO. Specific criteria used in the sonographic diagnosis of an SBO vary slightly in the medical literature, but the publications reviewed considered a fluid-filled small bowel lumen 2.5 cm to be consistent with the diagnosis of SBO. […] Ultrasound is a promising adjunct to the evaluation of a patient with a suspected SBO. It can be performed rapidly and with high accuracy, even in the hands of providers with minimal training. Further research on a larger scale is needed to continue to explore the utility of bedside US as a rapid, accurate and potentially life-saving option for imaging in patients with potential small bowel obstructions.

• #40 Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction

  https://www.mdpi.com/2075-4418/10/5/277

  Ultrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). […] This study evaluated the association between morphological and functional US signs in the diagnosis and staging (simple, decompensated and complicated), and the associations and prevalence of US signs correlated with clinical or surgical outcome. […] Imaging plays a significant role in making the diagnosis of SBO, as history and physical examination are unreliable. […] In these scenarios, multimodality imaging (X-rays, ultrasound, CT and MRI) has been proposed to confirm, stage and define the cause of SBO. […] Recent studies demonstrated that ultrasound (US) and bedside point-of-care ultrasound (POCUS) have a reasonably high accuracy in diagnosing small bowel obstruction compared with CT scan, representing a rapid diagnostic modality to diagnose SBO, determining the presence or absence of pathology and substantially decreasing the time to diagnosis.

• #41

  https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11181&id=3852192&print=1

  Ultrasonography is considered a useful imaging modality for the investigation of the intestinal obstruction. Advantages of ultrasonography compared to the conventional radiography in the diagnosis of intestinal obstruction include: the lack of ionizing radiation with the technique, no need for anaesthesia, reduction in the time required, observation of the intestinal motility, visualization of the intestinal wall layers and examination of adjacent structures such as lymph nodes, pancreas, liver and spleen that are not usually visible radiographically. […] The most consistent ultrasonographic findings in mechanical obstruction are the segmental fluid-filled dilated intestinal loops with increased or decreased peristaltic activity, pendulous movement of the ingesta, the presence of a foreign body or invaginated intestinal loops in the distended bowel and the presence of akinetic intestinal loops together with free abdominal fluid accumulation.

• #42 Small bowel obstruction: Diagnosis by ultrasonography

  https://www.aliem.com/small-bowel-obstruction-diagnosis-ultrasonography/

  Although highly accurate, both the CT and the MRI have the distinct disadvantages of not being able to performed at the bedside, as well as being time consuming, more costly, and in the case of CT, carrying the side effects of radiation and possible contrast reactions. Ultrasound is a bedside testing modality that has recently arisen as a viable alternative. […] Ultrasound has emerged as a possible adjunct in the accurate and timely diagnosis of SBO. Specific criteria used in the sonographic diagnosis of an SBO vary slightly in the medical literature, but the publications reviewed considered a fluid-filled small bowel lumen 2.5 cm to be consistent with the diagnosis of SBO. […] Ultrasound is a promising adjunct to the evaluation of a patient with a suspected SBO. It can be performed rapidly and with high accuracy, even in the hands of providers with minimal training. Further research on a larger scale is needed to continue to explore the utility of bedside US as a rapid, accurate and potentially life-saving option for imaging in patients with potential small bowel obstructions.

• #43 Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction

  https://www.mdpi.com/2075-4418/10/5/277

  The purpose of this study was to evaluate the association and prevalence of sonographic morphological and functional signs that may be helpful in differentiating simple and advanced SBO (decompensated and complicated). […] The US diagnostic criteria of bowel obstruction are the presence of dilated bowel loops (>2.5 cm) and abnormal peristalsis. […] Because SBO is a dynamic pathology that can resolve or evolve, other signs have been advocated for in the staging of SBO, signs that determine the stage of disease based on bowel parietal damage. […] The results of this study demonstrate that ultrasound findings reflect the pathological evolution of small bowel obstruction. […] The results of our study demonstrate that the dilation of the loops and the alteration of kinetics have a sensitivity (94%) and a specificity (96%) in the diagnosis of SBO, and that, in the staging of SBO, the presence of liquid and thick walls are the criteria for high sensitivity and diagnostic specificity for staging a decompensated or complicated SBO.

• #44

  https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11181&id=3852192&print=1

  Ultrasonography is considered a useful imaging modality for the investigation of the intestinal obstruction. Advantages of ultrasonography compared to the conventional radiography in the diagnosis of intestinal obstruction include: the lack of ionizing radiation with the technique, no need for anaesthesia, reduction in the time required, observation of the intestinal motility, visualization of the intestinal wall layers and examination of adjacent structures such as lymph nodes, pancreas, liver and spleen that are not usually visible radiographically. […] The most consistent ultrasonographic findings in mechanical obstruction are the segmental fluid-filled dilated intestinal loops with increased or decreased peristaltic activity, pendulous movement of the ingesta, the presence of a foreign body or invaginated intestinal loops in the distended bowel and the presence of akinetic intestinal loops together with free abdominal fluid accumulation.

• #45 Diagnostic Accuracy of Ultrasound for the Evaluation of Small Bowel Obstruction – TheNNT

  https://thennt.com/lr/diagnostic-accuracy-ultrasound-evaluation-small-bowel-obstruction/

  Diagnostic Accuracy of Ultrasound for the Evaluation of Small Bowel Obstruction […] Small bowel obstruction (SBO) comprises 2% of patients presenting to the emergency department (ED) with abdominal pain, with over 300,000 hospitalizations per year. […] If not appropriately diagnosed, SBO can result in intestinal ischemia, necrosis, and perforation. […] Traditional means of diagnosis such as plain film radiography suffer from poor sensitivity and specificity. […] Ultrasound has demonstrated promise in evaluation for SBO, as it is rapid, repeatable, inexpensive, does not expose the patient to radiation, and can be performed at the bedside. […] Overall, ultrasound was 92% sensitive (95% confidence interval [CI], 89% to 95%) and 97% specific (95% CI, 88% to 99%), with a positive likelihood ratio (LR+) of 27 (95% CI, 8 to 98) and a negative likelihood ratio (LR-) of 0.08 (95% CI, 0.06 to 0.11).

• #46 Small Bowel Obstruction 1 | Emory School of Medicine

  https://med.emory.edu/departments/emergency-medicine/sections/ultrasound/case-of-the-month/abdominal/small_bowel_obstruction1.html

  The patient presented with abdominal pain. Bedside ultrasound quickly captured Image 1. Notice a tubular structure, with a mixture of fluid (hypoechoic area) and debris (low-level echos). Also, note the image captures the classic „keyboard” sign (visualization of the plicae circularis) associated with the diagnosis – a small bowel obstruction (SBO). […] To diagnose SBO with the US, use the curvilinear probe and scan systematically over the abdomen. Look for fluid-filled, dilated loops of bowel (defined as 2.5cm). You may also see back and forth movements of echoes within the lumen as bowel contents move with dysfunctional peristalsis. The plicae circulares can be prominent as seen in this image. Although history, physical exam, and XR findings are the classic method to diagnose SBO, when performed by a skilled provider – can show both increased sensitivity and specificity vs traditional abdominal XR. […] After a 10-minute training session and 5 practice scans, residents at UCLA Olive View Medical Center were able to detect CT proven SBO with a sensitivity of 91% and specificity of 84%.

• #47 Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0185-2

  The initial diagnosis of ASBO is of utmost importance. […] The value of plain X-rays complementary to physical examination is limited. […] Current helical CT scans not only have good test characteristics for diagnosing small bowel obstruction but also have approximately 90% accuracy in predicting strangulation and the need for urgent surgery. […] The workgroup therefore considers CT scan to be the preferred imaging technique if there is any doubt about the diagnosis of ASBO, and to assess the need for urgent surgery. […] Non-operative management should always be tried in patients with adhesive small bowel obstruction, unless there are signs of peritonitis, strangulation, or bowel ischemia. […] The cornerstone of non-operative management is nil per os and decompression using a naso-gastric tube or long intestinal tube. […] Laparoscopic surgery has been introduced in recent years and might decrease morbidity in subgroups of patients undergoing surgery for ASBO. […] The risk of bowel injuries seems higher in laparoscopic surgery for ASBO.

• #48 Intestinal Obstruction Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/intestinal-obstruction/causes-and-diagnoses

  Capsule endoscopy: A tiny camera, embedded in a small capsule that you swallow, takes pictures of your digestive tract. […] Lower GI (barium enema): A series of X-rays are taken after you have received an enema containing barium, a contrast material that coats your colon and shows up well on X-rays. […] Colonoscopy: An endoscope (long, flexible tube) with a lighted camera goes through the colon, allowing your physician to view the lining. A sigmoidoscopy uses the same technology but examines only the sigmoid colon (the lower third).

• #49 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The initial evaluation of patients with clinical signs and symptoms of intestinal obstruction should include plain upright abdominal radiography. Radiography can quickly determine if intestinal perforation has occurred; free air can be seen above the liver in upright films or left lateral decubitus films. Radiography accurately diagnoses intestinal obstruction in approximately 60 percent of cases, and its positive predictive value approaches 80 percent in patients with high-grade intestinal obstruction. […] CT is appropriate for further evaluation of patients with suspected intestinal obstruction in whom clinical examination and radiography do not yield a definitive diagnosis. CT is sensitive for detection of high-grade obstruction (up to 90 percent in some series), and has the additional benefit of defining the cause and level of obstruction in most patients.

• #50 Small-Bowel Obstruction Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/374962-overview

  The use of barium suspensions for enteroclysis or retrograde examination may cause inspissation of the small bowel and convert a partial obstruction to a complete obstruction. […] The presence of a closed-loop obstruction and features of ischemia can be missed, even on CT scans. […] CT scanning is recommended when the clinical findings and the initial plain radiographs are inconclusive or when strangulation is suspected. […] The diagnosis of obstruction is based on the identification of a dilated proximal loop and a collapsed distal loop of small bowel. […] The reported sensitivity of CT scanning for detecting small-bowel obstruction is 78-100% in high-grade or complete obstruction. […] If the obstruction is partial or intermittent, the accuracy is low.

• #51 Small-Bowel Obstruction, Evaluation and Management of

  https://www.east.org/education-resources/practice-management-guidelines/details/smallbowel-obstruction-evaluation-and-management-of

  CT scan of abdomen and pelvis should be considered in all patients with SBO because it can provide incremental information over plain films in differentiating grade, severity, and etiology of SBOs that may lead to changes in management. Level 1. […] Water-soluble contrast study should be considered in patients who fail to improve after 48 hours of nonoperative management because a normal contrast study can rule out operative SBO. Level 2. […] CT findings consistent with bowel ischemia should suggest a low threshold for operative intervention. Level 2. […] CT scans have been shown in Class II and III studies to be superior to plain film radiography in the overall diagnosis of SBO. […] CT scans can determine not only the level of obstruction (93%) but also the cause (8091%) in most patients.

• #52 Intestinal obstruction – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/diagnosis-treatment/drc-20351465

  When an intestinal obstruction occurs in children, ultrasound is often the preferred type of imaging. In youngsters with an intussusception, an ultrasound will typically show a „bull’s-eye,” representing the intestine coiled within the intestine. […] An air or barium enema allows for enhanced imaging of the colon. This may be done for certain suspected causes of obstruction. During the procedure, the doctor will insert air or liquid barium into the colon through the rectum. For intussusception in children, an air or barium enema can actually fix the problem most of the time, and no further treatment is needed.

• #53 Bowel Obstruction and Blockage: Symptoms, Causes, and Treatment

  https://www.webmd.com/digestive-disorders/what-is-bowel-obstruction

  Bowel Obstruction Diagnosis Your doctor will ask about your medical history, including whether youve been constipated, if youve had cancer, and what symptoms youve had. They also may do a physical exam to see whether your belly is swollen, if they can hear noises that point to an obstruction, or if they can feel a lump. […] They may also order blood tests to look for signs of dehydration or infection. If they think you may have a bowel obstruction, they’ll likely use an imaging test to make the diagnosis. […] Several types of imaging tests can be used in diagnosing a bowel obstruction: […] An X-ray may reveal the location of the blockage and whether there are signs of a rupture or dead area in your intestine. But not all bowel obstructions show up on a standard X-ray. […] Your doctor may insert air or liquid containing a metallic substance called barium into your rectum to create images that are clearer than those of regular X-rays. For children with intussusception, either type of enema can actually unfold the inside-out section of bowel and correct the blockage. […] This test uses a series of X-ray images to create detailed cross-section pictures of your bowel. […] Doctors often use this type of imaging test on children with bowel obstruction. It uses high-frequency sound waves to create images of the intestine.

• #54 Small-Bowel Obstruction Workup: Laboratory Studies, Plain Radiography, Enteroclysis and CT Enterography

  https://emedicine.medscape.com/article/774140-workup

  If the diagnosis is unclear, admission and observation are warranted to detect early obstructions. Essential laboratory tests are needed, including the following: […] Obtain plain radiographs first for patients in whom small-bowel obstruction (SBO) is suspected. At least 2 views, supine or flat and upright, are required. Plain radiographs are diagnostically more accurate in cases of simple obstruction. However, diagnostic failure rates of as much as 30% have been reported. […] Enteroclysis is valuable in detecting the presence of obstruction and in differentiating partial from complete blockages. This study is useful when plain radiographic findings are normal in the presence of clinical signs of small-bowel obstruction (SBO) or when plain radiographic findings are nonspecific. […] CT scanning is useful in making an early diagnosis of strangulated obstruction and in delineating the myriad other causes of acute abdominal pain, particularly when clinical and radiographic findings are inconclusive. […] The accuracy of MRI almost approaches that of CT scanning for the detection of obstructions. […] Ultrasonography is less costly and invasive than CT scanning and may reliably exclude SBO in as many as 89% of patients; specificity is reportedly 100%.

• #55 Small-Bowel Obstruction Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/374962-overview

  Delabrousse et al evaluated the CT findings of 67 patients with small-bowel obstruction to identify characteristics of small-bowel obstruction caused by adhesive bands and that caused by matted adhesions. […] Although ultrasonography has no specific role in the diagnosis of an acute small-bowel obstruction, the technique is widely used in the investigation of acute abdominal pain. […] The diagnosis of small-bowel obstruction has been achieved by using magnetic resonance imaging (MRI) with T1-weighted sequences combined with antiperistaltic agents and retrograde insufflation. […] The sensitivity of plain radiographic findings in the diagnosis of small-bowel obstruction is approximately 50-66%. […] CT scans have poor sensitivity for low-grade, partial, or incomplete obstruction. […] The most serious consequences of small-bowel obstruction are strangulation with ischemia, necrosis, perforation, peritonitis, and death.

• #56 Intestinal Obstruction Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/intestinal-obstruction/causes-and-diagnoses

  Diagnosing intestinal obstructions […] There are several tests for diagnosing an intestinal obstruction, including: […] Blood test: Lab tests can determine if you have an infection or other illness that is causing the obstruction. […] Breath test: This test can measure how quickly the stomach is emptying. […] X-rays: X-ray images can indicate the location and severity of a blockage. […] Ultrasound: Ultrasound testing uses reflected sound waves to create images of the inside of your body. Unlike an X-ray or CT scan, there is no ionizing radiation exposure. […] CT scan: A computed tomography (CT) scan combines X-ray and computer technology to produce detailed cross-sectional images of your esophagus. […] Upper endoscopy: An endoscope (a thin, lighted tube with a camera attached to it) is passed through your mouth and esophagus to your stomach and duodenum. Your physician can look at pictures of your digestive tract and evaluate any abnormalities or blockages.

• #57 Bowel obstruction – Wikipedia

  https://en.wikipedia.org/wiki/Bowel_obstruction

  Colonoscopy, small bowel investigation with ingested camera or push endoscopy, and laparoscopy are other diagnostic options. […] Diagnosis of the type of bowel obstruction is normally conducted through initial plain radiograph of the abdomen, luminal contrast studies, computed tomography scan, or ultrasonography prior to determining the best type of treatment.

• #58 Intestinal Obstruction Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/intestinal-obstruction/causes-and-diagnoses

  Diagnosing intestinal obstructions […] There are several tests for diagnosing an intestinal obstruction, including: […] Blood test: Lab tests can determine if you have an infection or other illness that is causing the obstruction. […] Breath test: This test can measure how quickly the stomach is emptying. […] X-rays: X-ray images can indicate the location and severity of a blockage. […] Ultrasound: Ultrasound testing uses reflected sound waves to create images of the inside of your body. Unlike an X-ray or CT scan, there is no ionizing radiation exposure. […] CT scan: A computed tomography (CT) scan combines X-ray and computer technology to produce detailed cross-sectional images of your esophagus. […] Upper endoscopy: An endoscope (a thin, lighted tube with a camera attached to it) is passed through your mouth and esophagus to your stomach and duodenum. Your physician can look at pictures of your digestive tract and evaluate any abnormalities or blockages.

• #59 Intestinal Obstruction Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/intestinal-obstruction/causes-and-diagnoses

  Capsule endoscopy: A tiny camera, embedded in a small capsule that you swallow, takes pictures of your digestive tract. […] Lower GI (barium enema): A series of X-rays are taken after you have received an enema containing barium, a contrast material that coats your colon and shows up well on X-rays. […] Colonoscopy: An endoscope (long, flexible tube) with a lighted camera goes through the colon, allowing your physician to view the lining. A sigmoidoscopy uses the same technology but examines only the sigmoid colon (the lower third).

• #60 Bowel Obstruction: Symptoms, Treatment, and More

  https://www.verywellhealth.com/what-is-a-bowel-obstruction-1943010

  This is an invasive test in which a scope (tube with a camera) is inserted into the rectum to observe the colon from the inside. A colonoscopy can be very helpful to your medical team, but there is a risk involved (especially if you have a bowel obstruction or perforation), so it is not always the right option. It is only used once safety is established with non-invasive imaging tests. […] An invasive test in which a scope is placed in your mouth, endoscopy is used to assess the upper parts of your GI system—your esophagus, stomach, and upper small intestine. Like a colonoscopy, there are some risks, and use of this test is guided by preliminary information gathered from your non-invasive imaging tests.

• #61 Bowel obstruction | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/bowel-obstruction?lang=us

  Bowel obstructions are common and account for 20% of admissions with „surgical abdomens”. Radiology is important in confirming the diagnosis and identifying the underlying cause. […] Imaging plays an important role in both diagnosing bowel obstruction as well as helping determine the choice and timing of appropriate management. The main aims of imaging in cases of suspected bowel obstruction are: differentiate true mechanical obstruction from ileus or constipation, localize the site of obstruction, identify an underlying cause, assess for complications (e.g. ischemia or perforation), assess the viability of bowel segments involved. […] Once intestinal obstruction is confirmed imaging findings can guide the timing of any planned surgical intervention. In cases where there are signs of ischemia (i.e. strangulated bowel obstruction), emergency surgery may be needed to salvage bowel.

• #62 Chronic intestinal pseudo-obstruction: Etiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/chronic-intestinal-pseudo-obstruction-etiology-clinical-manifestations-and-diagnosis

  Chronic intestinal pseudo-obstruction: Etiology, clinical manifestations, and diagnosis […] Pseudo-obstruction is characterized by signs and symptoms of a mechanical obstruction of the small or large bowel in the absence of an obstructing anatomic lesion, and by the presence of dilation of the bowel on imaging. […] This topic review will discuss the etiology, clinical manifestations, diagnosis, and treatment of chronic intestinal pseudo-obstruction (CIPO). […] The dilatation may be associated with air-fluid levels on imaging studies and may involve the small bowel or colon or both. […] Patients with CIPO affecting either the small bowel or colon may have delayed gastric emptying or gastric dilatation, which may result from involvement of the stomach in the same disease process or that may result from reflex inhibition of gastric function or increased resistance to the flow of food from the stomach as a result of the impaired small bowel transit.

• #63 Intestinal obstruction – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/symptoms-causes/syc-20351460

  Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon). […] Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal obstruction often can be successfully treated. […] Because of the serious complications that can develop from intestinal obstruction, seek immediate medical care if you have severe abdominal pain or other symptoms of intestinal obstruction. […] The most common causes of intestinal obstruction in adults are: Intestinal adhesions bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery; Hernias portions of intestine that protrude into another part of your body; Colon cancer. […] Intestinal pseudo-obstruction (paralytic ileus) can cause signs and symptoms of intestinal obstruction, but it doesn’t involve a physical blockage.

• #64 What Is Ogilvie Syndrome (Acute Colonic Pseudo-Obstruction)?

  https://my.clevelandclinic.org/health/diseases/17141-ogilvie-syndrome

  Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a sudden and unexplained paralysis of your colon. Your colon acts like its blocked or obstructed by something (pseudo-obstruction) but nothing is physically obstructing it. The problem is in your colons motor system. It stops moving food along, allowing it to build up inside and causing the walls to dilate (widen). […] Diagnosis depends on: […] Radiology showing a dilated colon with no physical bowel obstruction. […] Specific tests to rule out other possible causes for your condition. […] To see the inside of your colon in detail, healthcare providers use a type of imaging that combines radiology with an internal contrast agent. The contrast material coats the inside of your colon to make features stand out better in black and white.

• #65 Small-Bowel Obstruction Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/374962-overview

  Stable patients should also undergo CT of the abdomen and pelvis with IV contrast. […] A transition zone is required for the diagnosis of small-bowel obstruction. […] CT of the abdomen and pelvis with IV contrast is usually appropriate for the initial imaging of a suspected small-bowel obstruction with an acute presentation. […] CT of the abdomen and pelvis with IV contrast or CT enterography is usually appropriate for the imaging of a suspected intermittent or low-grade small-bowel obstruction with an indolent presentation. […] Atri et al studied 99 adult patients who underwent 105 nonenhanced CTs and enhanced CTs and found that the 2 procedures had comparable accuracy in diagnosing mechanical small-bowel obstruction. […] O’Daly et al conducted a retrospective review of 88 patients who had acute adhesional small-bowel obstruction and underwent CT, and 58 (66%) were managed conservatively and 30 (34%) underwent surgery.

• #66 Small bowel obstruction | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/small-bowel-obstruction?lang=us

  Small bowel obstruction (SBO) refers to mechanical blockage of the transit of intestinal contents through the small bowel. CT in particular plays a key role in the diagnosis and can help identify the cause of obstruction and assess for potential complications. […] The diagnosis is usually made through CT and can be confirmed during laparotomy if surgery is required ref. Abdominal radiographs can serve as a first step toward diagnosing an obstruction but do not provide information about the cause, grade, or complications of the obstruction, and thus a CT is appropriate in most cases to guide management ref. […] Positive oral contrast is not usually necessary for the diagnosis of small bowel obstructions as it tends to dilute in the setting of SBO, does not reach the transition point, and may obscure the evaluation of the bowel wall (thereby limiting the evaluation of bowel ischemia) 4. […] In uncomplicated cases of adhesional small bowel obstruction, where complications such as ischemia or perforation are absent, a water-soluble contrast challenge may be employed. This approach serves both diagnostic and therapeutic purposes 5.

• #67 Intestinal Obstruction – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intestinal-obstruction

  Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. […] Diagnosis is clinical and confirmed by abdominal radiographs. […] Mechanical obstruction is divided into obstruction of the small bowel (including the duodenum) and obstruction of the large bowel. […] Approximately 85% of partial small-bowel obstructions resolve with nonoperative treatment, whereas most complete small-bowel obstructions require surgery. […] Symptoms include cramping pain, vomiting, obstipation, and lack of flatus. […] In simple mechanical obstruction, blockage occurs without vascular compromise. […] Elevated white blood cells and acidosis may indicate that strangulation has already occurred, but these signs may be absent if the venous outflow from the strangulated loop of bowel is decreased.

• #68 Diagnosis of Intestinal Pseudo-obstruction – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/intestinal-pseudo-obstruction/diagnosis

  To diagnose intestinal pseudo-obstruction, the doctor will ask about symptoms, review medical and family history, perform a physical exam, and order tests. […] To diagnose intestinal pseudo-obstruction, doctors review a patients history, perform a physical exam, and order tests. […] Doctors may order medical tests to rule out an intestinal obstructiona physical blockage in the intestinesand to diagnose intestinal pseudo-obstruction. […] Doctors may order different tests, depending on which type of pseudo-obstruction they think a person has. […] To diagnose chronic intestinal pseudo-obstruction, doctors may order blood tests, imaging tests such as computed tomography (CT) scans, endoscopy tests, biopsies, and other tests. […] To diagnose acute colonic pseudo-obstruction, doctors most often order blood tests and imaging tests, such as x-rays of the abdomen or CT scans.

• #69 Intestinal Obstruction – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intestinal-obstruction

  Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. […] Diagnosis is clinical and confirmed by abdominal radiographs. […] Mechanical obstruction is divided into obstruction of the small bowel (including the duodenum) and obstruction of the large bowel. […] Approximately 85% of partial small-bowel obstructions resolve with nonoperative treatment, whereas most complete small-bowel obstructions require surgery. […] Symptoms include cramping pain, vomiting, obstipation, and lack of flatus. […] In simple mechanical obstruction, blockage occurs without vascular compromise. […] Elevated white blood cells and acidosis may indicate that strangulation has already occurred, but these signs may be absent if the venous outflow from the strangulated loop of bowel is decreased.

• #70 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunctive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention.

• #71 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause. […] Imaging with abdominal radiography or computed tomography can confirm the diagnosis and assist in decision making for therapeutic planning. […] The decision to pursue nonoperative management or surgical intervention must be carefully determined by experienced clinicians. […] Abdominal radiography is an appropriate initial examination in patients with suspected intestinal obstruction. […] CT can reliably determine the cause of obstruction and associated complications. […] Admission to or consultation with a surgical service should occur upon diagnosis of intestinal obstruction. […] Surgical exploration is recommended for most patients in whom three to five days of nonoperative management is ineffective, or who clinically deteriorate at any point during hospitalization.

• #72 Bowel Obstruction: Signs & Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/bowel-obstruction

  A bowel obstruction is a medical emergency that requires immediate care. […] Small bowel (intestine) obstructions are a common reason people visit the ED. […] Large bowel obstructions are uncommon in the general population, but theyre frequent among people with colon cancer. About 40% of people with colon cancer get diagnosed because bowel obstruction symptoms (from a tumor) prompted them to seek emergency care. […] As a bowel obstruction is a medical emergency, diagnosis usually happens quickly. It may happen alongside treatment, so no time is lost. Diagnosis may involve: Medical history: Your healthcare provider will ask about your medical history, including whether youve had any previous abdominal surgeries. Physical examination: Your provider will perform a physical exam to check for a swollen abdomen or masses. They may use a stethoscope to listen for bowel sounds that signal an obstruction. Blood tests: You may need a complete blood count and electrolyte analysis. A blood test checks for signs of infection. Electrolyte levels can show if you have severe dehydration. If so, youll need fluids immediately.

• #73 Bowel Obstruction (small and large), Differential Diagnosis | Time of Care

  https://www.timeofcare.com/bowel-obstruction-small-and-large-differential-diagnosis/

  Proximal GI obstruction: Esophageal disorders/achalasia Pyloric stenosis […] Small bowel obstruction: Mechanical obstruction of the small intestine or proximal colon due to: -Adhesions, -Volvulus, -Intussusception -Strangulated hernia -Crohns disease -Malignancy Acute paralytic ileus due to: -GI or abdominal surgery -Peritoneal irritation, eg, pancreatitis, peritonitis, ruptured viscus -Severe medical illness, eg, sepsis, electrolyte abnormality -Drugs, eg, opioids, anticholinergics Myxedema (hypothyroidism) Chronic intestinal pseudo-obstruction […] Large Bowel Obstruction Mechanical obstruction of the colon from: -Malignancy: Colorectal cancer; Extracolonic tumors (peritoneal carcinomatosis, local invasion, lymphadenopathy) -Colonic Diverticulitis (causing strictures) -Fecal impaction, -Volvulus (Cecal volvulus, Sigmoid volvulus) -Adhesions -Ischemic stricture -Intussusception -Endometriosis -Inflammatory bowel disease (causing stricture) -Enterolith -Hernias Chronic intestinal pseudo-obstruction Toxic megacolon: From C. difficile colitis or inflammatory bowel disease. Megacolon due to: -Chagas disease, -Aganglionic megacolon (Hirschsprungs disease), -multiple sclerosis, sacral nerve damage, -myxedema (hypothyroidism) Colonic pseudo-obstruction (Ogilvies syndrome) associated with: -MI or CHF -Pancreatitis -Intestinal ischemia -Cancer -Respiratory failure -Stroke or subarachnoid hemorrhage -Trauma, burns, or postoperative -Drugs, eg, opioids, anticholinergics Adynamic ileus

• #74 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The American College of Radiology recommends non-contrast CT as the initial imaging modality of choice. However, because most causes of small bowel obstruction will have systemic manifestations or fail to resolve necessitating operative intervention the additional diagnostic value of CT compared with radiography is limited. […] Conservative management is successful in 40 to 70 percent of clinically stable patients, with a higher success rate in those with partial obstruction. Although conservative management is associated with shorter initial hospitalization, there is also a higher rate of eventual recurrence. With conservative management, resolution generally occurs within 24 to 48 hours. Beyond this time frame, the risk of complications, including vascular compromise, increases. If intestinal obstruction is not resolved with conservative management, surgical evaluation is required.

• #75 Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0185-2

  The initial diagnosis of ASBO is of utmost importance. […] The value of plain X-rays complementary to physical examination is limited. […] Current helical CT scans not only have good test characteristics for diagnosing small bowel obstruction but also have approximately 90% accuracy in predicting strangulation and the need for urgent surgery. […] The workgroup therefore considers CT scan to be the preferred imaging technique if there is any doubt about the diagnosis of ASBO, and to assess the need for urgent surgery. […] Non-operative management should always be tried in patients with adhesive small bowel obstruction, unless there are signs of peritonitis, strangulation, or bowel ischemia. […] The cornerstone of non-operative management is nil per os and decompression using a naso-gastric tube or long intestinal tube. […] Laparoscopic surgery has been introduced in recent years and might decrease morbidity in subgroups of patients undergoing surgery for ASBO. […] The risk of bowel injuries seems higher in laparoscopic surgery for ASBO.

• #76 Intestinal Pseudo-Obstruction Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/intestinal-pseudo-obstruction/diagnosis.html

  Intestinal pseudo obstruction is a rare condition that can be difficult to diagnose because your symptoms can mimic other disorders. […] With a team of gastrointestinal motility experts and a dedicated Neurogastroenterology, Motility and Functional Disorders Program, we excel in quickly and accurately diagnosing your condition at Stanford Health Care. […] You may need one or more tests including: […] Abdominal computed tomography (CT) scan: Using X-rays and special computer software, this test creates two- and three-dimensional images of your intestines. […] Barium study: Drinking a special chemical (barium) and tracking its journey down your intestinal tract, this advanced imaging study produces sharp images of your bowels. […] Gastric emptying study: Using advanced imaging technology and a tiny amount of radioactive (nuclear) material to examine how quickly you move food from your stomach to your small intestine after eating a small meal.

• #77 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The American College of Radiology recommends non-contrast CT as the initial imaging modality of choice. However, because most causes of small bowel obstruction will have systemic manifestations or fail to resolve necessitating operative intervention the additional diagnostic value of CT compared with radiography is limited. […] Conservative management is successful in 40 to 70 percent of clinically stable patients, with a higher success rate in those with partial obstruction. Although conservative management is associated with shorter initial hospitalization, there is also a higher rate of eventual recurrence. With conservative management, resolution generally occurs within 24 to 48 hours. Beyond this time frame, the risk of complications, including vascular compromise, increases. If intestinal obstruction is not resolved with conservative management, surgical evaluation is required.

• #78 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The American College of Radiology recommends non-contrast CT as the initial imaging modality of choice. However, because most causes of small bowel obstruction will have systemic manifestations or fail to resolve necessitating operative intervention the additional diagnostic value of CT compared with radiography is limited. […] Conservative management is successful in 40 to 70 percent of clinically stable patients, with a higher success rate in those with partial obstruction. Although conservative management is associated with shorter initial hospitalization, there is also a higher rate of eventual recurrence. With conservative management, resolution generally occurs within 24 to 48 hours. Beyond this time frame, the risk of complications, including vascular compromise, increases. If intestinal obstruction is not resolved with conservative management, surgical evaluation is required.

• #79 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Nonoperative management is successful in 40% to 70% of clinically stable patients with acute intestinal obstruction and is associated with shorter initial hospitalization. […] Surgical exploration is recommended in patients who clinically deteriorate at any point during hospitalization and in those for whom three to five days of nonoperative management is ineffective.

• #80 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunctive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention.

• #81 Diagnosis and management of small bowel obstruction in virgin abdomen: a WSES position paper | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-021-00379-8

  One of the main priorities in the initial assessment of the patient with SBO-VA is to identify indications for emergent surgical exploration. […] Indications for emergency operation are signs of peritonitis, strangulation, and ischemia. […] The ability of computed tomography (CT) to provide information related to the underlying cause of SBO, and predict the need for emergency surgery, makes CT the primary diagnostic tool of choice in patients with SBO. […] Findings on CT scan help define the potential location of the obstruction (e.g., high in the jejunum or deep in the pelvis), the grade of the obstruction, partial or complete, and may also identify a possible transition zone. […] The use of water-soluble contrast optimizes the diagnostic value of CT scan, and X-ray can evaluate the progress of the contrast at 24 h after CT.

• #82 Diagnosis and management of small bowel obstruction in virgin abdomen: a WSES position paper | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-021-00379-8

  One of the main priorities in the initial assessment of the patient with SBO-VA is to identify indications for emergent surgical exploration. […] Indications for emergency operation are signs of peritonitis, strangulation, and ischemia. […] The ability of computed tomography (CT) to provide information related to the underlying cause of SBO, and predict the need for emergency surgery, makes CT the primary diagnostic tool of choice in patients with SBO. […] Findings on CT scan help define the potential location of the obstruction (e.g., high in the jejunum or deep in the pelvis), the grade of the obstruction, partial or complete, and may also identify a possible transition zone. […] The use of water-soluble contrast optimizes the diagnostic value of CT scan, and X-ray can evaluate the progress of the contrast at 24 h after CT.

• #83 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Laboratory evaluation of patients with suspected obstruction should include a complete blood count, metabolic panel, and serum lactate level. […] In most patients with SBO, abdominal radiography with supine views shows dilation of multiple loops of small bowel, with a paucity of gas in the large bowel. […] The American College of Radiology recommends computed tomography (CT) as the initial imaging modality for evaluation of intestinal obstruction in patients with high clinical suspicion. […] When these guidelines are followed, CT is sensitive for detection of high-grade obstruction and can define the cause and level of obstruction in most patients. […] Surgical consultation should be sought after diagnosis of obstruction in inpatients admitted to nonsurgical services. […] Management of acute intestinal obstruction is directed at correcting physiologic derangements, providing bowel rest and decompression, and removing the source of obstruction.

• #84 Small-Bowel Obstruction, Evaluation and Management of

  https://www.east.org/education-resources/practice-management-guidelines/details/smallbowel-obstruction-evaluation-and-management-of

  CT findings suggestive of ischemia include reduced bowel wall enhancement; wall thickening; mesenteric venous congestion; mesenteric fluid; unusual course of the mesenteric vasculature; and ascites. […] Water-soluble contrast studies can accurately predict the need for surgery and reduce the need for operation and shorten hospital stay. […] Early operative management should be pursued in patients with suspected bowel strangulation because this is associated with an increased morbidity and mortality. […] The initial management of patients with complete SBO remains controversial. […] Patients without clinical or radiologic signs and symptoms of bowel ischemia can safely undergo initial nonoperative management. […] Nonoperative management is overall successful in 65% to 80% of patients, especially in the setting of partial SBO and early postoperative period SBO.

• #85 Small-Bowel Obstruction Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/374962-overview

  Delabrousse et al evaluated the CT findings of 67 patients with small-bowel obstruction to identify characteristics of small-bowel obstruction caused by adhesive bands and that caused by matted adhesions. […] Although ultrasonography has no specific role in the diagnosis of an acute small-bowel obstruction, the technique is widely used in the investigation of acute abdominal pain. […] The diagnosis of small-bowel obstruction has been achieved by using magnetic resonance imaging (MRI) with T1-weighted sequences combined with antiperistaltic agents and retrograde insufflation. […] The sensitivity of plain radiographic findings in the diagnosis of small-bowel obstruction is approximately 50-66%. […] CT scans have poor sensitivity for low-grade, partial, or incomplete obstruction. […] The most serious consequences of small-bowel obstruction are strangulation with ischemia, necrosis, perforation, peritonitis, and death.

• #86 Intestinal Obstruction – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intestinal-obstruction

  Supine and upright abdominal radiographs should be taken and are usually adequate to diagnose obstruction. […] Abdominal CT is being used more often in suspected small-bowel obstruction. […] Patients with possible intestinal obstruction should be hospitalized. […] Treatment of acute intestinal obstruction must proceed simultaneously with diagnosis. […] A surgeon should always be involved. […] If bowel ischemia or infarction is suspected, antibiotics should be given before operative exploration. […] Complete obstruction of the small bowel is preferentially treated with early laparotomy, although surgery can be delayed 2 or 3 hours to improve fluid status and urine output in a very ill, dehydrated patient. […] The obstructing lesion is removed whenever possible. […] In most patients with early postoperative obstruction or repeated obstruction caused by adhesions, nasogastric decompression through a sump tube may be attempted in the absence of peritoneal signs.

• #87 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause. […] Imaging with abdominal radiography or computed tomography can confirm the diagnosis and assist in decision making for therapeutic planning. […] The decision to pursue nonoperative management or surgical intervention must be carefully determined by experienced clinicians. […] Abdominal radiography is an appropriate initial examination in patients with suspected intestinal obstruction. […] CT can reliably determine the cause of obstruction and associated complications. […] Admission to or consultation with a surgical service should occur upon diagnosis of intestinal obstruction. […] Surgical exploration is recommended for most patients in whom three to five days of nonoperative management is ineffective, or who clinically deteriorate at any point during hospitalization.

• #88 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunctive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention.

• #89 Bowel Obstruction: Signs & Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/bowel-obstruction

  Most people with bowel obstruction need prompt treatment in the hospital. Complete obstructions usually require immediate surgery. Partial bowel obstructions may require treatments to stabilize your condition, followed by nonsurgical solutions, like bowel rest. It all depends on how severe the obstruction is. […] If youre noticing symptoms of a bowel obstruction, act fast to seek care. In general, many people wait out pain, worrying that seeing a provider is an overreaction. But when it comes to a bowel obstruction, toughing it out is never a good option. Take abdominal pain seriously, especially if youve had previous abdominal surgery or if you have a condition that increases your risk, like IBD. An obstruction is a treatable condition that you can recover from with prompt medical attention. Don’t delay.

• #90 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause. […] Imaging with abdominal radiography or computed tomography can confirm the diagnosis and assist in decision making for therapeutic planning. […] The decision to pursue nonoperative management or surgical intervention must be carefully determined by experienced clinicians. […] Abdominal radiography is an appropriate initial examination in patients with suspected intestinal obstruction. […] CT can reliably determine the cause of obstruction and associated complications. […] Admission to or consultation with a surgical service should occur upon diagnosis of intestinal obstruction. […] Surgical exploration is recommended for most patients in whom three to five days of nonoperative management is ineffective, or who clinically deteriorate at any point during hospitalization.

• #91 Small-Bowel Obstruction, Evaluation and Management of

  https://www.east.org/education-resources/practice-management-guidelines/details/smallbowel-obstruction-evaluation-and-management-of

  In patients who do not have resolution of SBO within 48 hours of admission, Class I and II data support performing contrast studies before operative intervention to differentiate complete from partial SBO. […] A preponderance of Class III studies has demonstrated that laparoscopic surgery for SBO is a safe and acceptable alternative to open surgery. […] Successful laparoscopic surgery is associated with an earlier recovery of bowel function and a shorter length of stay. […] There are Class III data to suggest that patients with SBO admitted to a surgical service have shorter length of stay, less hospital charges, shorter time to surgery, and lower mortality than patients admitted to medical service.

• #92 Small-Bowel Obstruction, Evaluation and Management of

  https://www.east.org/education-resources/practice-management-guidelines/details/smallbowel-obstruction-evaluation-and-management-of

  In patients who do not have resolution of SBO within 48 hours of admission, Class I and II data support performing contrast studies before operative intervention to differentiate complete from partial SBO. […] A preponderance of Class III studies has demonstrated that laparoscopic surgery for SBO is a safe and acceptable alternative to open surgery. […] Successful laparoscopic surgery is associated with an earlier recovery of bowel function and a shorter length of stay. […] There are Class III data to suggest that patients with SBO admitted to a surgical service have shorter length of stay, less hospital charges, shorter time to surgery, and lower mortality than patients admitted to medical service.

• #93 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause. […] Imaging with abdominal radiography or computed tomography can confirm the diagnosis and assist in decision making for therapeutic planning. […] The decision to pursue nonoperative management or surgical intervention must be carefully determined by experienced clinicians. […] Abdominal radiography is an appropriate initial examination in patients with suspected intestinal obstruction. […] CT can reliably determine the cause of obstruction and associated complications. […] Admission to or consultation with a surgical service should occur upon diagnosis of intestinal obstruction. […] Surgical exploration is recommended for most patients in whom three to five days of nonoperative management is ineffective, or who clinically deteriorate at any point during hospitalization.

• #94 Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0185-2

  The initial diagnosis of ASBO is of utmost importance. […] The value of plain X-rays complementary to physical examination is limited. […] Current helical CT scans not only have good test characteristics for diagnosing small bowel obstruction but also have approximately 90% accuracy in predicting strangulation and the need for urgent surgery. […] The workgroup therefore considers CT scan to be the preferred imaging technique if there is any doubt about the diagnosis of ASBO, and to assess the need for urgent surgery. […] Non-operative management should always be tried in patients with adhesive small bowel obstruction, unless there are signs of peritonitis, strangulation, or bowel ischemia. […] The cornerstone of non-operative management is nil per os and decompression using a naso-gastric tube or long intestinal tube. […] Laparoscopic surgery has been introduced in recent years and might decrease morbidity in subgroups of patients undergoing surgery for ASBO. […] The risk of bowel injuries seems higher in laparoscopic surgery for ASBO.

• #95 Diagnosis and management of small bowel obstruction in virgin abdomen: a WSES position paper | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-021-00379-8

  One of the main priorities in the initial assessment of the patient with SBO-VA is to identify indications for emergent surgical exploration. […] Indications for emergency operation are signs of peritonitis, strangulation, and ischemia. […] The ability of computed tomography (CT) to provide information related to the underlying cause of SBO, and predict the need for emergency surgery, makes CT the primary diagnostic tool of choice in patients with SBO. […] Findings on CT scan help define the potential location of the obstruction (e.g., high in the jejunum or deep in the pelvis), the grade of the obstruction, partial or complete, and may also identify a possible transition zone. […] The use of water-soluble contrast optimizes the diagnostic value of CT scan, and X-ray can evaluate the progress of the contrast at 24 h after CT.

• #96 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The American College of Radiology recommends non-contrast CT as the initial imaging modality of choice. However, because most causes of small bowel obstruction will have systemic manifestations or fail to resolve necessitating operative intervention the additional diagnostic value of CT compared with radiography is limited. […] Conservative management is successful in 40 to 70 percent of clinically stable patients, with a higher success rate in those with partial obstruction. Although conservative management is associated with shorter initial hospitalization, there is also a higher rate of eventual recurrence. With conservative management, resolution generally occurs within 24 to 48 hours. Beyond this time frame, the risk of complications, including vascular compromise, increases. If intestinal obstruction is not resolved with conservative management, surgical evaluation is required.

• #97 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Nonoperative management is successful in 40% to 70% of clinically stable patients with acute intestinal obstruction and is associated with shorter initial hospitalization. […] Surgical exploration is recommended in patients who clinically deteriorate at any point during hospitalization and in those for whom three to five days of nonoperative management is ineffective.

• #98 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The American College of Radiology recommends non-contrast CT as the initial imaging modality of choice. However, because most causes of small bowel obstruction will have systemic manifestations or fail to resolve necessitating operative intervention the additional diagnostic value of CT compared with radiography is limited. […] Conservative management is successful in 40 to 70 percent of clinically stable patients, with a higher success rate in those with partial obstruction. Although conservative management is associated with shorter initial hospitalization, there is also a higher rate of eventual recurrence. With conservative management, resolution generally occurs within 24 to 48 hours. Beyond this time frame, the risk of complications, including vascular compromise, increases. If intestinal obstruction is not resolved with conservative management, surgical evaluation is required.

• #99 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The American College of Radiology recommends non-contrast CT as the initial imaging modality of choice. However, because most causes of small bowel obstruction will have systemic manifestations or fail to resolve necessitating operative intervention the additional diagnostic value of CT compared with radiography is limited. […] Conservative management is successful in 40 to 70 percent of clinically stable patients, with a higher success rate in those with partial obstruction. Although conservative management is associated with shorter initial hospitalization, there is also a higher rate of eventual recurrence. With conservative management, resolution generally occurs within 24 to 48 hours. Beyond this time frame, the risk of complications, including vascular compromise, increases. If intestinal obstruction is not resolved with conservative management, surgical evaluation is required.

• #100 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Nonoperative management is successful in 40% to 70% of clinically stable patients with acute intestinal obstruction and is associated with shorter initial hospitalization. […] Surgical exploration is recommended in patients who clinically deteriorate at any point during hospitalization and in those for whom three to five days of nonoperative management is ineffective.

• #101 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  The American College of Radiology recommends non-contrast CT as the initial imaging modality of choice. However, because most causes of small bowel obstruction will have systemic manifestations or fail to resolve necessitating operative intervention the additional diagnostic value of CT compared with radiography is limited. […] Conservative management is successful in 40 to 70 percent of clinically stable patients, with a higher success rate in those with partial obstruction. Although conservative management is associated with shorter initial hospitalization, there is also a higher rate of eventual recurrence. With conservative management, resolution generally occurs within 24 to 48 hours. Beyond this time frame, the risk of complications, including vascular compromise, increases. If intestinal obstruction is not resolved with conservative management, surgical evaluation is required.

• #102 Intestinal obstruction – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/diagnosis-treatment/drc-20351465

  When an intestinal obstruction occurs in children, ultrasound is often the preferred type of imaging. In youngsters with an intussusception, an ultrasound will typically show a „bull’s-eye,” representing the intestine coiled within the intestine. […] An air or barium enema allows for enhanced imaging of the colon. This may be done for certain suspected causes of obstruction. During the procedure, the doctor will insert air or liquid barium into the colon through the rectum. For intussusception in children, an air or barium enema can actually fix the problem most of the time, and no further treatment is needed.

• #103 Intestinal Atresia & Stenosis | Types, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/i/intestinal-atresia-stenosis

  Intestinal atresia is a broad term used to describe a complete blockage or obstruction anywhere in the intestine. […] Stenosis refers to a partial obstruction that results in a narrowing of the opening (lumen) of the intestine. […] The frequencies, symptoms and methods of diagnosis differ depending on the site of intestinal involvement. Nevertheless, children with all forms of intestinal atresia require surgical treatment. […] Intestinal obstructions are increasingly being identified through prenatal ultrasounds. This imaging technique may indicate excess amniotic fluid (polyhydramnios), which is caused by the failure of the intestine to properly absorb amniotic fluid. […] If your physician suspects intestinal atresia or stenosis, your infant will undergo the following diagnostic procedures after being stabilized: Abdominal X-ray: In most cases, this can establish a diagnosis.

• #104 Intestinal obstruction – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/diagnosis-treatment/drc-20351465

  When an intestinal obstruction occurs in children, ultrasound is often the preferred type of imaging. In youngsters with an intussusception, an ultrasound will typically show a „bull’s-eye,” representing the intestine coiled within the intestine. […] An air or barium enema allows for enhanced imaging of the colon. This may be done for certain suspected causes of obstruction. During the procedure, the doctor will insert air or liquid barium into the colon through the rectum. For intussusception in children, an air or barium enema can actually fix the problem most of the time, and no further treatment is needed.

• #105 Bowel Obstruction and Blockage: Symptoms, Causes, and Treatment

  https://www.webmd.com/digestive-disorders/what-is-bowel-obstruction

  Bowel Obstruction Diagnosis Your doctor will ask about your medical history, including whether youve been constipated, if youve had cancer, and what symptoms youve had. They also may do a physical exam to see whether your belly is swollen, if they can hear noises that point to an obstruction, or if they can feel a lump. […] They may also order blood tests to look for signs of dehydration or infection. If they think you may have a bowel obstruction, they’ll likely use an imaging test to make the diagnosis. […] Several types of imaging tests can be used in diagnosing a bowel obstruction: […] An X-ray may reveal the location of the blockage and whether there are signs of a rupture or dead area in your intestine. But not all bowel obstructions show up on a standard X-ray. […] Your doctor may insert air or liquid containing a metallic substance called barium into your rectum to create images that are clearer than those of regular X-rays. For children with intussusception, either type of enema can actually unfold the inside-out section of bowel and correct the blockage. […] This test uses a series of X-ray images to create detailed cross-section pictures of your bowel. […] Doctors often use this type of imaging test on children with bowel obstruction. It uses high-frequency sound waves to create images of the intestine.

• #106 Intestinal obstruction – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/diagnosis-treatment/drc-20351465

  When an intestinal obstruction occurs in children, ultrasound is often the preferred type of imaging. In youngsters with an intussusception, an ultrasound will typically show a „bull’s-eye,” representing the intestine coiled within the intestine. […] An air or barium enema allows for enhanced imaging of the colon. This may be done for certain suspected causes of obstruction. During the procedure, the doctor will insert air or liquid barium into the colon through the rectum. For intussusception in children, an air or barium enema can actually fix the problem most of the time, and no further treatment is needed.

• #107

  https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11181&id=3852192&print=1

  Ultrasonography is a sensitive and specific method in detection of intestinal intussusceptions in dogs and cats. The multiple hyperechoic and hypoechoic concentric rings around an echogenic core in transverse sections and the multiple hyperechoic and hypoechoic parallel lines in longitudinal sections are characteristic ultrasonographic patterns of this condition. […] Intestinal tumours are the most common cause and can be readily detected ultrasonographically as asymmetric thickening of the intestinal wall and disruption of its layered appearance. Differentiation between intestinal tumours and inflammatory bowel diseases as granulomas and transmural granulomatous enteritis is usually difficult, although inflammation is usually characterized by extensive symmetric wall thickening without loss of the layered appearance. […] Hernias, containing intestinal loops are easily detectable by ultrasound. Colour and pulsed wave Doppler technique may be used to estimate the viability of the entrapped intestine.

• #108 Intestinal obstruction – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/diagnosis-treatment/drc-20351465

  When an intestinal obstruction occurs in children, ultrasound is often the preferred type of imaging. In youngsters with an intussusception, an ultrasound will typically show a „bull’s-eye,” representing the intestine coiled within the intestine. […] An air or barium enema allows for enhanced imaging of the colon. This may be done for certain suspected causes of obstruction. During the procedure, the doctor will insert air or liquid barium into the colon through the rectum. For intussusception in children, an air or barium enema can actually fix the problem most of the time, and no further treatment is needed.

• #109 Intestinal Atresia & Stenosis | Types, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/i/intestinal-atresia-stenosis

  Lower gastrointestinal (GI) series: This is a procedure that examines the rectum, large intestine and lower part of the small intestine. An X-ray contrast agent is given into the rectum as an enema; this coats the inside of the intestines, allowing them to be seen on an X-ray. An abdominal X-ray may show narrowed areas (strictures), obstructions, the width (caliber) of the bowel and other problems. […] Upper GI series: This procedure examines the organs of the upper part of the digestive system. It is particularly useful in cases where there is an upper intestinal obstruction (pyloric or duodenal atresia). A liquid called barium, which shows up well on X-rays, is given orally or administered through a small tube placed through the mouth or nose into the stomach. X-rays are then taken to evaluate the digestive organs.

• #110 Intestinal obstruction – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/symptoms-causes/syc-20351460

  Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon). […] Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal obstruction often can be successfully treated. […] Because of the serious complications that can develop from intestinal obstruction, seek immediate medical care if you have severe abdominal pain or other symptoms of intestinal obstruction. […] The most common causes of intestinal obstruction in adults are: Intestinal adhesions bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery; Hernias portions of intestine that protrude into another part of your body; Colon cancer. […] Intestinal pseudo-obstruction (paralytic ileus) can cause signs and symptoms of intestinal obstruction, but it doesn’t involve a physical blockage.

• #111 What Is Ogilvie Syndrome (Acute Colonic Pseudo-Obstruction)?

  https://my.clevelandclinic.org/health/diseases/17141-ogilvie-syndrome

  Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a sudden and unexplained paralysis of your colon. Your colon acts like its blocked or obstructed by something (pseudo-obstruction) but nothing is physically obstructing it. The problem is in your colons motor system. It stops moving food along, allowing it to build up inside and causing the walls to dilate (widen). […] Diagnosis depends on: […] Radiology showing a dilated colon with no physical bowel obstruction. […] Specific tests to rule out other possible causes for your condition. […] To see the inside of your colon in detail, healthcare providers use a type of imaging that combines radiology with an internal contrast agent. The contrast material coats the inside of your colon to make features stand out better in black and white.

• #112 Diagnosis of Intestinal Pseudo-obstruction – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/intestinal-pseudo-obstruction/diagnosis

  To diagnose intestinal pseudo-obstruction, the doctor will ask about symptoms, review medical and family history, perform a physical exam, and order tests. […] To diagnose intestinal pseudo-obstruction, doctors review a patients history, perform a physical exam, and order tests. […] Doctors may order medical tests to rule out an intestinal obstructiona physical blockage in the intestinesand to diagnose intestinal pseudo-obstruction. […] Doctors may order different tests, depending on which type of pseudo-obstruction they think a person has. […] To diagnose chronic intestinal pseudo-obstruction, doctors may order blood tests, imaging tests such as computed tomography (CT) scans, endoscopy tests, biopsies, and other tests. […] To diagnose acute colonic pseudo-obstruction, doctors most often order blood tests and imaging tests, such as x-rays of the abdomen or CT scans.

• #113 Chronic intestinal pseudo-obstruction: Etiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/chronic-intestinal-pseudo-obstruction-etiology-clinical-manifestations-and-diagnosis

  Chronic intestinal pseudo-obstruction: Etiology, clinical manifestations, and diagnosis […] Pseudo-obstruction is characterized by signs and symptoms of a mechanical obstruction of the small or large bowel in the absence of an obstructing anatomic lesion, and by the presence of dilation of the bowel on imaging. […] This topic review will discuss the etiology, clinical manifestations, diagnosis, and treatment of chronic intestinal pseudo-obstruction (CIPO). […] The dilatation may be associated with air-fluid levels on imaging studies and may involve the small bowel or colon or both. […] Patients with CIPO affecting either the small bowel or colon may have delayed gastric emptying or gastric dilatation, which may result from involvement of the stomach in the same disease process or that may result from reflex inhibition of gastric function or increased resistance to the flow of food from the stomach as a result of the impaired small bowel transit.

• #114 Chronic intestinal pseudo-obstruction: Etiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/chronic-intestinal-pseudo-obstruction-etiology-clinical-manifestations-and-diagnosis

  Chronic intestinal pseudo-obstruction: Etiology, clinical manifestations, and diagnosis […] Pseudo-obstruction is characterized by signs and symptoms of a mechanical obstruction of the small or large bowel in the absence of an obstructing anatomic lesion, and by the presence of dilation of the bowel on imaging. […] This topic review will discuss the etiology, clinical manifestations, diagnosis, and treatment of chronic intestinal pseudo-obstruction (CIPO). […] The dilatation may be associated with air-fluid levels on imaging studies and may involve the small bowel or colon or both. […] Patients with CIPO affecting either the small bowel or colon may have delayed gastric emptying or gastric dilatation, which may result from involvement of the stomach in the same disease process or that may result from reflex inhibition of gastric function or increased resistance to the flow of food from the stomach as a result of the impaired small bowel transit.

• #115 What Is Ogilvie Syndrome (Acute Colonic Pseudo-Obstruction)?

  https://my.clevelandclinic.org/health/diseases/17141-ogilvie-syndrome

  Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a sudden and unexplained paralysis of your colon. Your colon acts like its blocked or obstructed by something (pseudo-obstruction) but nothing is physically obstructing it. The problem is in your colons motor system. It stops moving food along, allowing it to build up inside and causing the walls to dilate (widen). […] Diagnosis depends on: […] Radiology showing a dilated colon with no physical bowel obstruction. […] Specific tests to rule out other possible causes for your condition. […] To see the inside of your colon in detail, healthcare providers use a type of imaging that combines radiology with an internal contrast agent. The contrast material coats the inside of your colon to make features stand out better in black and white.

• #116 Bowel obstruction – Wikipedia

  https://en.wikipedia.org/wiki/Bowel_obstruction

  Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. The diagnosis may be made on plain X-rays; however, CT scan is more accurate. Ultrasound or MRI may help in the diagnosis of children or pregnant women. […] The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning, and ultrasound. If a mass is identified, biopsy may determine the nature of the mass. […] Radiological signs of bowel obstruction include bowel distension (small bowel loops dilated 3 cm) and the presence of multiple (more than 2) air-fluid levels on supine and erect abdominal radiographs. […] Contrast enema or small bowel series or CT scan can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.

• #117 Bowel obstruction – Wikipedia

  https://en.wikipedia.org/wiki/Bowel_obstruction

  Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. The diagnosis may be made on plain X-rays; however, CT scan is more accurate. Ultrasound or MRI may help in the diagnosis of children or pregnant women. […] The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning, and ultrasound. If a mass is identified, biopsy may determine the nature of the mass. […] Radiological signs of bowel obstruction include bowel distension (small bowel loops dilated 3 cm) and the presence of multiple (more than 2) air-fluid levels on supine and erect abdominal radiographs. […] Contrast enema or small bowel series or CT scan can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.

• #118 Bowel obstruction – Wikipedia

  https://en.wikipedia.org/wiki/Bowel_obstruction

  Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. The diagnosis may be made on plain X-rays; however, CT scan is more accurate. Ultrasound or MRI may help in the diagnosis of children or pregnant women. […] The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning, and ultrasound. If a mass is identified, biopsy may determine the nature of the mass. […] Radiological signs of bowel obstruction include bowel distension (small bowel loops dilated 3 cm) and the presence of multiple (more than 2) air-fluid levels on supine and erect abdominal radiographs. […] Contrast enema or small bowel series or CT scan can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.

• #119 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunctive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention.

• #120 Bowel Obstruction: Signs & Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/bowel-obstruction

  Most people with bowel obstruction need prompt treatment in the hospital. Complete obstructions usually require immediate surgery. Partial bowel obstructions may require treatments to stabilize your condition, followed by nonsurgical solutions, like bowel rest. It all depends on how severe the obstruction is. […] If youre noticing symptoms of a bowel obstruction, act fast to seek care. In general, many people wait out pain, worrying that seeing a provider is an overreaction. But when it comes to a bowel obstruction, toughing it out is never a good option. Take abdominal pain seriously, especially if youve had previous abdominal surgery or if you have a condition that increases your risk, like IBD. An obstruction is a treatable condition that you can recover from with prompt medical attention. Don’t delay.

• #121 Bowel obstruction – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/bowel-obstruction/

  Bowel obstruction typically manifests with nausea, vomiting, abdominal pain, abdominal distention, and constipation or obstipation. […] A diagnosis of bowel obstruction should be confirmed on imaging (e.g., CT abdomen and pelvis). […] Imaging is required to confirm mechanical bowel obstruction, identify the site and assess the severity of the obstruction, identify complications and the underlying etiology of the obstruction, and guide treatment planning. […] Bowel obstruction requires a swift diagnostic workup to establish if emergency surgery is required. […] Initial imaging modality depends on the type of bowel obstruction and hemodynamic stability of the patient. […] CT abdomen and pelvis is the gold standard for diagnosing bowel obstruction. […] In acute bowel obstruction, a CT scan is more accurate than an x-ray in the identification of the site of obstruction, complications, and underlying etiology, and, therefore, influences patient management to a greater extent.

• #122 Small Bowel Obstruction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448079/

  Small bowel obstruction (SBO) is a common surgical emergency resulting from mechanical or functional disruption of intestinal transit. […] Diagnosis involves clinical assessment and imaging, with computed tomography being the gold standard to identify the transition point, ischemia, or perforation. […] This activity examines the pathophysiology, clinical presentation, diagnostic workup, and management strategies for SBO, emphasizing evidence-based practices and recent advances in care. […] Imaging, particularly computed tomography (CT), is pivotal in confirming the diagnosis and guiding treatment. […] The initial imaging study of choice is usually a plain abdominal radiograph (x-ray). […] A CT scan of the abdomen is considered the gold standard for diagnosing SBO. […] Radiologic evaluation is central to confirming the diagnosis of SBO and assessing its location, severity, and complications.

• #123 Small bowel obstruction: Diagnosis by ultrasonography

  https://www.aliem.com/small-bowel-obstruction-diagnosis-ultrasonography/

  Although highly accurate, both the CT and the MRI have the distinct disadvantages of not being able to performed at the bedside, as well as being time consuming, more costly, and in the case of CT, carrying the side effects of radiation and possible contrast reactions. Ultrasound is a bedside testing modality that has recently arisen as a viable alternative. […] Ultrasound has emerged as a possible adjunct in the accurate and timely diagnosis of SBO. Specific criteria used in the sonographic diagnosis of an SBO vary slightly in the medical literature, but the publications reviewed considered a fluid-filled small bowel lumen 2.5 cm to be consistent with the diagnosis of SBO. […] Ultrasound is a promising adjunct to the evaluation of a patient with a suspected SBO. It can be performed rapidly and with high accuracy, even in the hands of providers with minimal training. Further research on a larger scale is needed to continue to explore the utility of bedside US as a rapid, accurate and potentially life-saving option for imaging in patients with potential small bowel obstructions.

• #124 Small Bowel Obstruction 1 | Emory School of Medicine

  https://med.emory.edu/departments/emergency-medicine/sections/ultrasound/case-of-the-month/abdominal/small_bowel_obstruction1.html

  The patient presented with abdominal pain. Bedside ultrasound quickly captured Image 1. Notice a tubular structure, with a mixture of fluid (hypoechoic area) and debris (low-level echos). Also, note the image captures the classic „keyboard” sign (visualization of the plicae circularis) associated with the diagnosis – a small bowel obstruction (SBO). […] To diagnose SBO with the US, use the curvilinear probe and scan systematically over the abdomen. Look for fluid-filled, dilated loops of bowel (defined as 2.5cm). You may also see back and forth movements of echoes within the lumen as bowel contents move with dysfunctional peristalsis. The plicae circulares can be prominent as seen in this image. Although history, physical exam, and XR findings are the classic method to diagnose SBO, when performed by a skilled provider – can show both increased sensitivity and specificity vs traditional abdominal XR. […] After a 10-minute training session and 5 practice scans, residents at UCLA Olive View Medical Center were able to detect CT proven SBO with a sensitivity of 91% and specificity of 84%.

• #125 Small Bowel Obstruction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448079/

  Laboratory testing in SBO primarily assesses the patient’s overall health, identifies complications, and helps to monitor for signs of dehydration, electrolyte imbalance, or infection. […] The evaluation of SBO involves a combination of laboratory tests, radiographic imaging, and occasionally more specialized studies. […] The treatment and management of SBO require a multidisciplinary approach that prioritizes early recognition and intervention to optimize patient outcomes. […] Surgical intervention is indicated for patients with evidence of strangulation, such as fever, tachycardia, localized tenderness, leukocytosis, or acidosis. […] Surgical options depend on the underlying cause of SBO. […] Optimal management of SBO relies on collaboration among surgeons, radiologists, gastroenterologists, critical care specialists, pharmacists, and nursing teams. […] Early diagnosis and prompt management significantly improve outcomes, while delays in treatment are associated with higher morbidity and mortality rates.

• #126 Intestinal Obstruction and Ileus | Doctor

  https://patient.info/doctor/intestinal-obstruction-and-ileus

  In acute colonic pseudo-obstruction, if perforation or ischaemia occurs the mortality is 40%. […] In patients with small bowel obstruction, the mortality is 14% if surgery is delayed, compared to 3% if this is performed immediately. […] The prognosis of advanced carcinoma of the colon remains poor. A high proportion of patients who present with obstruction have distant metastases. […] 50% of sigmoid volvulus will recur in the following two years. […] Older patients, patients with hypoalbuminaemia and those in whom the primary tumour is not gastrointestinal in origin are less able to withstand the rigours of major surgery.

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