How and when to use barium for diagnosis of small bowel obstruction

The diagnosis of intestinal obstruction is readily made when a patient presents with typical history and signs, and when plain films of the abdomen display characteristic findings. Some patients, however, constitute diagnostic problems because abdominal roentgenograms are still equivocal, even after repetition in four hours. In the unclear case, use of a barium meal will safely, promptly, and routinely prove or disprove small bowel obstruction. Intestinal obstruction in which the initial abdominal films tend to be either unrevealing or equivocal include high obstructions, including the superior mesenteric artery syndrome; presence of strangulation; partial small bowel obstruction; and fluid-filled proximal bowel. In intestinal obstruction, characteristic roentgenographic findings with use of barium meal are normal to rather rapid transit time to the point of obstruction; homogenous dilution of barium in dilated proximal loops; and inhomogenous, scattered, and fragmented collections of barium in the distal, collapsed loops.     

Congenital microvillous inclusion disease presenting as antenatal bowel obstruction.

Prenatal ultrasound has led to confidence in the antenatal diagnosis of intestinal obstruction allowing counseling and birth planning. We describe a male infant of a diabetic mother who had an antenatal diagnosis of distal bowel obstruction. This baby was subsequently found not to have bowel obstruction, but a congenital enteropathy - microvillous inclusion disease. The antenatal scans had demonstrated polyhydramnios as well as multiple fluid-filled dilated loops of bowel in the fetal abdomen. To our knowledge, similar prenatal ultrasound findings have not been previously described in this condition. The baby was delivered in a pediatric surgical center and postnatally there was no evidence of bowel obstruction either clinically or on abdominal X-ray. This baby initially fed well, but became collapsed and acidotic on his third day, having lost 26% of his birth weight due to excessive stool loss. The diagnosis of microvillous inclusion disease was made by electron microscopy of a small bowel biopsy. Congenital microvillous inclusion disease is a very rare inherited enteropathy with high mortality and morbidity. This condition, and other enteropathies, should be considered in cases in which antenatally diagnosed bowel obstruction is not confirmed after birth.     

Prenatal diagnosis of bowel obstruction initially manifested as isolated hyperechoic bowel.

Fetal bowel obstruction has a prevalence of 1 in 3000 to 5000 live births. Ultrasonographic diagnosis is made by demonstrating distended loops of bowel. Echogenic bowel, defined as small bowel more echogenic than liver or bone, has been associated with congenital infections, cystic fibrosis, chromosomal abnormalities, and bowel obstruction. Fetal ascites, defined as fluid in the peritoneal cavity partly surrounding the liver and bladder, also has been associated with bowel obstruction. We present a case of jejunal atresia whose presenting appearance consists of echogenic bowel, transient ascites, and massive dilatation of intestinal loops.     

The use of MRI in bowel obstruction

Nine patients with clinical or radiographic evidences of bowel obstruction were examined by magnetic resonance imaging. Retrograde insufflation of 1000–1200 ml of air through a Foley catheter placed in the rectum was employed. Scopolamine was used to inhibit bowel peristalsis and possibly relax the ileocecal valve. The administered air successfully distended the colon and the small bowel distal to the obstruction in seven of the nine cases. The air-filled small bowel loops were useful in delineating the obstruction sites and adjacent lesions in these seven cases. The diagnosis was established by means of surgery in six cases and by clinical course in three cases. The causes of obstruction included four peritoneal carcinomatoses, and one each of supravesical hernia, intussusception, adhesive band, benign granulomatous stricture, and radiational stricture. The site of obstruction was the distal small bowel in eight cases, and the rectosigmoid colon in one case.     

Strangulated transmesosigmoid hernia: CT diagnosis

We present a rare case of strangulated closed loop small bowel obstruction secondary to a trans-mesosigmoid hernia to emphasize the diagnostic role of computed tomography in patients with no history of previous surgery. The characteristic computed tomographic features showed a cluster of dilated, fluid-filled, U- and C-shaped loops of small bowel entrapped the left posterior and lateral to the sigmoid colon through a defect in the mesosigmoid, which caused anterior and medial displacement of the sigmoid colon.     

Acute Surgical Abdomen Due to Phytobezoar-induced Ileal Obstruction

Background

Phytobezoar-induced small bowel obstruction is an uncommon clinical entity accounting for 2–4.8% of all mechanical intestinal obstructions. In addition, presentation with features of acute surgical abdomen is extremely rare, accounting for only 1% of the patients.

Objectives

The aim of this report is to present a very rare case of a phytobezoar-induced small bowel obstruction in a male patient who presented with acute surgical abdomen. A correct preoperative diagnosis was made based on the patient’s history and characteristic imaging features on the emergency computed tomography (CT) scan.

Case Report

A 55-year-old man with previous gastrectomy presented with typical manifestations of acute abdomen. CT scan demonstrated dilatated small bowel loops and an intraluminal ileal mass with a mottled appearance. At exploratory laparotomy, a phytobezoar was found impacted in the terminal ileum and was removed through an enterotomy.

Conclusions

Phytobezoar should be considered in patients with previous gastric outlet surgery who present with bowel obstruction and features of acute surgical abdomen. The presence of a well-defined intraluminal mass with a mottled gas pattern on emergency CT scan is suggestive of an intestinal phytobezoar.     

Early diagnosis of bowel obstruction and strangulation by computed tomography in emergency department

BACKGROUND:

Closed loop bowel obstruction is a specific type of mechanical obstruction with a high risk of strangulation and bowel infarction, especially in the small bowel. It is associated with a high mortality rate. Hence, it is important for emergency physicians to identify the presence of strangulation, while making the diagnosis of closed loop small bowel obstruction.

METHODS:

We reported three patients with strangulated closed loop small bowel obstruction associated with severe abdominal pain, who had been treated at the emergency department. Urgent computerized tomography was performed in the patients.

RESULTS:

Two patients were discharged with stable conditions, and one patient died after hemodialysis.

CONCLUSION:

Urgent computerized tomography of the abdomen serves as an important diagnostic tool in view of its ability to detect the site, level and cause of obstruction along with the distinctive CT appearance of closed loop small bowel obstruction and signs of ischemia. Early definitive diagnosis will guide subsequent management and improve outcomes.KEY WORDS: Closed loop small bowel obstruction, Computed tomography, Ischemia, Strangulation     

Sonographic findings in gastroschisis.

The antenatal sonographic appearance of gastroschisis is described. The findings consist of numerous extra-abdominal "cystic masses" respresenting loops of fluid-filled bowel eviscerated through the abdominal defect. This patient also had associated polyhydramnios, possibly on the basis of a functional bowel abnormality.     

Plum Stones: An unusual cause of ileostomy obstruction demonstrated by sonography

Bowel obstruction is a common cause of stomal complications of ileostomy. We report a case in which sonography revealed 2 well-defined, rounded, hyperechoic structures, measuring 1.7 cm in diameter and causing dense acoustic shadowing, in the lumen of the bowel of a 3-year-old boy with a permanent end ileostomy. Endoscopy showed the structures to be freely mobile plum stones in the fluid-filled terminal ileum. This case demonstrates the usefulness of sonography in the diagnostic workup of patients with ileostomy obstruction. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:416–417, 1998.     

The distended gasless abdomen: a fertile field for ultrasound

Ultrasonography has proven to be a helpful imaging modality in evaluating the child with a distended gasless abdomen. The presence of an unsuspected mass can easily be detected as well as the presence of ascites and/or abnormally dilated loops of small bowel. Thickened loops of bowel can also be easily detected in the abdomen with very little gas. Closed loop obstruction and intussusception, as well as meconium ileus equivalent (distal intestinal obstruction syndrome), are described.     

肠梗阻的多排螺旋CT诊断研究

目的 探讨肠梗阻在多层螺旋CT(MSCT，Multi-slice spiral CT)中的表现和MSCT诊断肠梗阻的优势。方法 回顾性总结28例临床怀疑为肠梗阻病例的MSCT检查结果，并将其中MSCT确诊为肠梗阻的病例与临床手术结果对照．扫描采用MSCT平扫或平扫后增强扫描，成像方法为薄层横断面、多方位重建成像。结果 有23例MSCT诊断为不同程度肠梗阻，其中18例经手术治疗，CT报告梗阻部位正确的为17例，病因诊断正确的为17例。与手术结果对照，符合率均为94％。临床怀疑肠梗阻而MSCT检查后排除的另5例中有3例发现其他病变，MSCT检查结果与手术完全符合。结论 MSCT对肠梗阻的程度、部位和梗阻原因的诊断及病变区血供情况的了解有重大意义．可作为肠梗阻的首选检查方法.     

Subtle vaginal evisceration resulting in small bowel evisceration: a case report

Background

Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction.

Objective

We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence.

Case Report

A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina. She was initially discharged home after bedside reduction of the mass, but returned 48 h later with worsening symptoms. A computed tomography scan on her repeat visit confirmed evisceration of bowel into the vaginal vault with obstruction of distal bowel loops. Surgical and gynecologic services were consulted and the patient underwent partial small bowel resection and vaginal cuff repair in the operating room.

Conclusion

Early recognition of subtle presentations of vaginal evisceration is crucial for preserving bowel viability and preventing morbidity from bowel ischemia or infarction. Risk factors for this rare condition include postmenopausal status, previous pelvic surgery, and presence of an enterocele.     

深在性囊性结肠炎并发肠梗阻1例报告和文献复习

报告１例少见病：深在性囊性结肠炎,患者因反复腹痛,腹泻低热,贫血,消瘦２年余入院,因并发不完全性小肠梗阻,持续１个月不缓解,而行剖腹探查。行右半结肠和部分小肠切除术,明确诊断,术后病情缓解。本病的组织病理特征为多发性囊肿性病变位于肠壁的粘膜下层,囊肿壁内衬以细胞无异常的单层柱状,立方或扁平上皮,病变周围有慢性炎细胞浸润。结合文献复习,对本病的病因、临床特点、诊断、鉴别诊断和治疗进行了讨论。     

Computed tomographic findings in bowel ischemia

Computed tomography (CT) has been used in the evaluation of 11 patients with ischemic bowel lesions before confirmation of the disease with surgery or autopsy. The CT abnormalities were thickened bowel wall (10 patients) with post-contrast enhancement (9 patients), dilated fluid-filled bowel (9 patients), intramural low attenuation zones (5 patients), intramural gas (8 patients), and focal or diffuse free intraperitoneal fluid (5 patients). The diagnosis of bowel ischemia should be considered when performing CT in patients with abdominal pain of unknown etiology.     

Small bowel obstruction due to internal hernia caused by the ureter after laparoscopic radical cystectomy and ileal conduit: A case report

A 74‐year‐old man presented at our hospital with complaints of abdominal pain, nausea, and vomiting. He had undergone laparoscopic radical cystectomy and ileal conduit for urinary bladder cancer 1 month earlier. The patient had abdominal distention, resonant sounds on percussion, and diffuse abdominal tenderness without rebound or guarding. Abdominal CT revealed dilated jejunal loops herniated through a cord‐like structure. Based on these findings, emergency surgery was performed, and intestinal dilatation into the space between the ureter, the ileal conduit, and the sacral bone was detected. The loops were released manually and were not resected. To the best of our knowledge, this is the first case report of small bowel obstruction due to internal hernia caused by the ureter after laparoscopic radical cystectomy and ileal conduit. Retroperitonealization and the minimum required mobilization of the ureters may be necessary when urinary diversion is constructed, especially in laparoscopic or robotic surgeries.     

多层螺旋CT重组图像诊断肠梗阻移行带的价值

目的 探讨多层螺旋CT（MSCT）后处理技术对于肠梗阻移行带的诊断价值.方法 65例肠梗阻患者行全腹部MSCT扫描,比较常规横轴面图像及联合后处理技术在肠梗阻移行带的显示、部位及病因等方面的差异.结果 MSCT常规横断面图像、联合后处理图像均能显示肠梗阻,二者对于肠梗阻的定位符合率分别为95.38%、98.46%.移行带的显示率分别为76.92%、90.77%,差异有统计学意义（P＜0.05）.病因诊断符合率分别为73.85%、87.69%,两者差异具有统计学意义（P＜0.05）,尤其对于粘连及疝所致肠梗阻.结论 联合运用后处理技术在显示移行带及梗阻原因方面优于常规横轴面图像.     

小肠机械性肠梗阻的CT诊断

目的 探讨小肠机械性肠梗阻病因的CT表现和诊断价值。方法 对53例小肠机械性肠梗阻的CT表现与手术、病理和临床随诊结果对照分析。结果 53例小肠机械性肠梗阻病因中，肠粘连18例，炎症10例，肠肿瘤8例，腹外疝6例，腹内疝3例，异物4例，肠套叠3例，肠扭转1例，CT诊断小肠机械性肠梗阻病因的符合率5％(49／53)。结论 CT对小肠机械性肠梗阻病因有较高的诊断价值。     

粘连性肠梗阻的CT诊断

目的:探讨粘连性肠梗阻的CT征象及诊断。方法:行腹部CT平扫及增强扫描,回顾性分析经手术病理和临床随访结果证实的54例粘连性肠梗阻的CT征象。结果:CT检查发现粘连索条和腹腔束带46例。粘连段肠管改变54例,包括肠管皱缩42例,梗阻部位鸟嘴征15例,肠袢粘连成团5例。移行区炎症4例,恶性肿瘤腹腔转移恶性粘连4例。肠绞窄征象5例。结论:CT能明确诊断粘连性肠梗阻及其原因,并有效提示肠绞窄。     

多层螺旋 CT 对小肠梗阻的诊断价值

目的：探讨多层螺旋C T对小肠梗阻的诊断价值。方法对36例小肠梗阻患者进行多层螺旋C T平扫和增强扫描,并利用工作站对C T图像进行多平面重建,将C T诊断结果与手术病理结果相对照。结果36例小肠梗阻患者均通过多层螺旋C T扫描明确诊断,诊断准确率为100．0％,均表现为小肠扩张、积液和积气;梗阻原因中肠粘连16例,肿瘤性病变5例,炎症性病变5例,腹疝5例,肠套叠3例,粪石2例,病因诊断准确率为94．4％。结论多层螺旋CT结合三维重建能够准确诊断小肠梗阻,并且在确定梗阻病因方面具有优越性。     

Prenatal diagnosis of choledochal cyst: a case report

Choledochal cyst is one of the intra-abdominal abnormalities of the biliary ducts that present as a cystic mass in the right upper quadrant abdomen. Prenatal diagnosis has been achieved by the demonstration of a connection between a dilated common bile duct and a cystic lesion. In this report, we describe a pregnant woman in whom routine fetal anomaly scan strongly suggested a choledochal cyst at 29 weeks of gestation by demonstrating a round cystic mass in the right upper quadrant of the abdomen, completely separated from the stomach, bowel loops, and gall bladder, and which showed a connection with the dilated common bile duct.