The diagnostic value of different imaging modalities in evaluation of bowel obstruction.

Abstract

The aim of the study was analysing of the diagnostic value of different imaging modalities in evaluation patients with bowel obstruction. The material comprises a group of 47 patients with diagnosed acute abdomen. Erect radiography, and radiographs in supine and left lateral patients' positions, US and CT examination were performed in those patients. CT examination was performed in 5 mm--and 10-mm thick axial sections before and after administering the contrast agent. In 6 patients small barium enema was performed. In 5 cases water-soluble contrast was administered orally. In 6 cases on plane radiographs the presence of high small bowel obstruction was found. In 3 cases the level of small bowel obstruction was in the distal ileum. In 12 patients the obstruction of large bowel was seen on plain radiographs. In 3 patients intussusception of sigmoid bowel was found. The mesenteric ischemia was found to be a reason of bowel obstruction in 5 cases. On CT section soft tissue mass with irregular contrast enhancement was found, reflecting ischemic intestinal loops. In 2 patients the gall stone small bowel obstruction was found. In one of them the presence of gas in the biliary tree was seen on CT images. The determining of the level of the obstruction is facilitated on plain radiographs, erect and in supine and left lateral patients' position. In small bowel obstruction, normal or equivocal initial radiographs may result in a delayed diagnosis. As the bowel diameter cannot be assessed the plain radiographic diagnosis is difficult or impossible. If there is persistent diagnostic difficulty, follow-up plain radiographs taken a few hours later will often resolve the problem and, if not, a barium study or CT may be performed. Orally administering of water-soluble contrast agent, diluted barium, barium enema are also helpful in differentiating the character and etiology of obstruction.