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== Overview ==
There is no single diagnostic study of choice for the diagnosis of bowel obstruction, but bowel obstruction can be diagnosed based on plain [[X-rays|X-ray]] and [[Computed tomography|CT scan]]. An [[x-ray]] is performed when obstruction is suspected with clinical findings of [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]], [[abdominal pain]], [[abdominal distension]] and [[constipation]]. The results of plain [[X-rays|X-ray]] that confirm of bowel obstruction include dilated [[bowel]] loops with air-fluid level, distal collapsed [[bowel]], gasless [[abdomen]] or alternatively, "string of pearls" sign. The results of [[Computed tomography|CT]] that confirm of bowel obstruction include dilated bowel loops with air-fluid level and distal collapsed [[bowel]]. Initially, an [[X-rays|X-ray]] is usually performed before surgical intervention. If urgent intervention is not needed and the diagnosis is equivocal, then a [[Computed tomography|CT]] may be carried out.


== Diagnostic Study of Choice ==
=== Study of choice: ===
*There is no single diagnostic study of choice for the diagnosis of bowel obstruction, but bowel obstruction can be diagnosed based on plain [[X-rays|X-ray]] and [[Computed tomography|CT scan]].<ref name="pmid21255429">{{cite journal |vauthors=Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J |title=Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery |journal=World J Emerg Surg |volume=6 |issue= |pages=5 |year=2011 |pmid=21255429 |pmc=3037327 |doi=10.1186/1749-7922-6-5 |url=}}</ref><ref name="pmid17230614">{{cite journal |vauthors=Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I |title=Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome |journal=World J. Gastroenterol. |volume=13 |issue=3 |pages=432–7 |year=2007 |pmid=17230614 |pmc=4065900 |doi= |url=}}</ref><ref name="pmid22268199">{{cite journal |vauthors=Mullan CP, Siewert B, Eisenberg RL |title=Small bowel obstruction |journal=AJR Am J Roentgenol |volume=198 |issue=2 |pages=W105–17 |year=2012 |pmid=22268199 |doi=10.2214/AJR.10.4998 |url=}}</ref>
*The following result of plain [[x-ray]] is confirmatory of bowel obstruction:
**Dilated bowel loops with air-fluid level
**Distal collapsed bowel
**Gasless abdomen or alternatively, "string of pearls" sign
*The [[X-rays|X-ray]] should be performed when:
**The patient is suspected of needing intervention and presents with symptoms of obvious distress, [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]], [[abdominal distension]], [[abdominal pain]] and [[constipation]].
*The following result of [[CT scan]] is confirmatory of bowel obstruction:
**Dilated [[bowel]] loops with air-fluid level
**Distal collapsed [[bowel]]
***Additional signs:
****"Target sign" – indicates [[intussusception]]
****"Whirl sign" – indicates [[volvulus]] 
****"Venous cut-off sign" - indicates [[thrombosis]]
*It should be noted that bowel obstruction may be diagnosed based on clinical presentation alone.
==== The comparison table for diagnostic studies of choice for bowel obstruction<ref name="pmid10394872">{{cite journal |vauthors=Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD |title=Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction |journal=Acta Radiol |volume=40 |issue=4 |pages=422–8 |year=1999 |pmid=10394872 |doi= |url=}}</ref> ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |CT
| style="background: #DCDCDC; padding: 5px; text-align: center;" |93%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |X-ray
| style="background: #DCDCDC; padding: 5px; text-align: center;" |50%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |75%
|}
===== Sequence of Diagnostic Studies =====
*The plain [[X-rays|X-ray]] should be performed when:<ref name="pmid17312028">{{cite journal |vauthors=Thompson WM, Kilani RK, Smith BB, Thomas J, Jaffe TA, Delong DM, Paulson EK |title=Accuracy of abdominal radiography in acute small-bowel obstruction: does reviewer experience matter? |journal=AJR Am J Roentgenol |volume=188 |issue=3 |pages=W233–8 |year=2007 |pmid=17312028 |doi=10.2214/AJR.06.0817 |url=}}</ref>
**The patient is suspected of needing intervention and presents with symptoms of obvious distress, [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]], [[abdominal distension]], [[abdominal pain]] and [[constipation]].
*CT scan is performed when:
**The patient is not in need of immediate intervention
**The diagnosis is equivocal
**To identify specific site, severity of obstruction (complete or partial), [[etiology]] and [[Complication (medicine)|complications]]
=== Diagnostic Criteria ===
There are no established criteria for the diagnosis of bowel obstruction.


==References==
==References==
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
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[[Category:Radiology]]


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Latest revision as of 15:51, 27 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

There is no single diagnostic study of choice for the diagnosis of bowel obstruction, but bowel obstruction can be diagnosed based on plain X-ray and CT scan. An x-ray is performed when obstruction is suspected with clinical findings of nausea, vomiting, abdominal pain, abdominal distension and constipation. The results of plain X-ray that confirm of bowel obstruction include dilated bowel loops with air-fluid level, distal collapsed bowel, gasless abdomen or alternatively, "string of pearls" sign. The results of CT that confirm of bowel obstruction include dilated bowel loops with air-fluid level and distal collapsed bowel. Initially, an X-ray is usually performed before surgical intervention. If urgent intervention is not needed and the diagnosis is equivocal, then a CT may be carried out.

Diagnostic Study of Choice

Study of choice:

  • There is no single diagnostic study of choice for the diagnosis of bowel obstruction, but bowel obstruction can be diagnosed based on plain X-ray and CT scan.[1][2][3]
  • The following result of plain x-ray is confirmatory of bowel obstruction:
    • Dilated bowel loops with air-fluid level
    • Distal collapsed bowel
    • Gasless abdomen or alternatively, "string of pearls" sign
  • The X-ray should be performed when:
  • The following result of CT scan is confirmatory of bowel obstruction:
  • It should be noted that bowel obstruction may be diagnosed based on clinical presentation alone.

The comparison table for diagnostic studies of choice for bowel obstruction[4]

Sensitivity Specificity
CT 93% 100%
X-ray 50% 75%
Sequence of Diagnostic Studies

Diagnostic Criteria

There are no established criteria for the diagnosis of bowel obstruction.

References

  1. ↑ Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J (2011). "Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery". World J Emerg Surg. 6: 5. doi:10.1186/1749-7922-6-5. PMC 3037327. PMID 21255429.
  2. ↑ Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I (2007). "Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome". World J. Gastroenterol. 13 (3): 432–7. PMC 4065900. PMID 17230614.
  3. ↑ Mullan CP, Siewert B, Eisenberg RL (2012). "Small bowel obstruction". AJR Am J Roentgenol. 198 (2): W105–17. doi:10.2214/AJR.10.4998. PMID 22268199.
  4. ↑ Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD (1999). "Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction". Acta Radiol. 40 (4): 422–8. PMID 10394872.
  5. ↑ Thompson WM, Kilani RK, Smith BB, Thomas J, Jaffe TA, Delong DM, Paulson EK (2007). "Accuracy of abdominal radiography in acute small-bowel obstruction: does reviewer experience matter?". AJR Am J Roentgenol. 188 (3): W233–8. doi:10.2214/AJR.06.0817. PMID 17312028.

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