Imaging AXR: Dilated small bowel loops above the level of the obstruction and transition point with normal small bowel loops below the level of the obstruction and transition point
Imaging Small bowel follow through: Dilated small bowel loops above the level of the obstruction and transition point with normal small bowel loops below the level of the obstruction and transition point
Imaging CT: — Dilated fluid-filled small bowel loops above the level of the obstruction and transition point with acute change in bowel caliber and then normal or smaller caliber small bowel loops below the level of the obstruction and transition point — Absence of gastrointestinal contrast in distal bowel — Small bowel feces sign above transition point — Mesenteric swirl or whirlpool sign in cases of obstruction due to small bowel volvulus — Wall thickening — Pneumatosis intestinalis in cases of high-grade obstruction and bowel ischemia — Decreased enhancement of bowel wall in cases of high-grade obstruction and bowel ischemia — Ascites
Treatment: Conservative decompression via nasogastric tube versus surgery
Clinical: — Adhesions are most common cause of small bowel obstruction in child with history of prior abdominal surgery — Most small bowel obstruction is partial as almost always some gas passes through the level of obstruction to the colon
Radiology Cases of Small Bowel Obstruction Due to Adhesion
AXR supine (left) shows several dilated loops of bowel in the left upper quadrant. Upper GI and small bowel follow through delayed image (right) shows contrast filling several dilated loops of jejunum with no contrast passing distally into the colon.AXR supine (left) shows multiple dilated loops of small bowel and a paucity of gas in the colon. Image from an upper GI and small bowel follow through exam the next day (right) shows interval increasing dilation of the loops of small bowel. Contrast never reached the colon.
Radiology Cases of Closed Loop Small Bowel Obstruction Due to Adhesion
AXR supine (left) shows multiple dilated loops of small bowel that have a stacked appearance. AXR upright (right) shows multiple air fluid levels within those loops of small bowel.
Surgical Cases of Small Bowel Obstruction Due to Adhesion
Surgical image shows dilated and congested loops of small intestine in the upper right corner and normal sized decompressed loops of small bowel adjacent to them. A volvulus was noted at the level of the terminal ileum, caused by adhesions from the cecum to the small bowel, forming a closed loop obstruction that was causing bowel wall congestion.
Radiology Cases of Small Bowel Obstruction Due to Appendicitis
AXR supine (left) shows multiple dilated loops of small bowel that have air fluid levels on the AXR upright (right). There is also a suggestion of a soft tissue mass in the right lower quadrant which is displacing the bowel loops medially.
Radiology Cases of Small Bowel Obstruction Due to Crohn Disease
AXR AP (left) shows dilated loops of small bowel and a radiopaque coin projecting over the pelvis. AP images from an upper GI and small bowel follow through exam show the coin cannot pass through the terminal ileum (above right) because the terminal ileum is ulcerated, nodular and narrowed (below right).
Radiology Cases of Small Bowel Obstruction Due to Inguinal Hernia
AXR supine shows massively dilated loops of bowel filling the abdomen with a loop of bowel noted in each of the scrotal sacs.
Radiology Cases of Small Bowel Obstruction Due to Intussusception
AXR supine (left) shows decompressed loops of bowel (presumed jejunum) in the left upper quadrant and multiple dilated loops of bowel (presumed ileum) in the right lower quadrant. AXR upright (right) shows multiple air-fluid levels.AXR AP (left) and AXR left lateral decubitus (right) show multiple distended loops of small bowel with multiple air fluid levels. There was no gas in the colon and no free air. As the patient had peritoneal signs, no further imaging was performed.AXR supine (left) shows multiple dilated loops of small bowel. AXR upright (right) shows a round soft tissue mass filling the lumen of the mid transverse colon. AP image from an air enema (below) shows reduction of the soft tissue mass to the cecum just before it disappeared and a large amount of air was observed to reflux into the terminal ileum.AXR supine (above left) shows multiple dilated loops of small bowel and AXR upright (above right) shows multiple air-fluid levels. There is no air in the colon. AP image from an air exam (below) shows a soft tissue mass outlined by air in the hepatic flexure which was then easily reduced to the ileocecal valve on the first attempt but could not be reduced further on subsequent attempts. In the operating room the terminal ileum and cecum were found to be necrotic and were resected.Axial (above), coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows multiple dilated loops of small bowel and a soft tissue mass in the right upper quadrant just beneath the gall bladder that shows the target sign on the sagittal image and the pseudokidney sign on the transverse and coronal images. The soft tissue mass was still present on an US performed 1 hour later.
Surgery Cases of Small Bowel Obstruction Due to Intussusception
Surgical image shows an ileocolic intussusception extending into the mid ascending colon with a dusky terminal ileum (to the right) intussuscepting into the cecum (to the left). Note that the appendix (in the middle of the image) is intussuscepted with the ileum. The intussusception was reduced without great difficulty manually. No lead point was seen.
Radiology Cases of Small Bowel Obstruction Due to Malrotation With Midgut Volvulus
AXR supine shows multiple dilated loops of bowel with thickened walls.
Radiology Cases of Small Bowel Obstruction Due to Meckel Diverticulum
AXR upright (left) shows multiple dilated loops of small bowel with air fluid levels. Sagittal US of the abdomen (above right) shows multiple dilated loops of peristalsing small bowel, however an intussusception was not seen. AP image from an upper GI exam (below right) shows the duodenal-jejunal junction to be low in position and to be to the right of the spine.Transverse US of the right lower quadrant (above) shows a round structure with a hyperechoic center and a hypoechoic rim (target sign). AXR supine (below left) shows multiple dilated loops of air-filled small bowel. Final AP image from an air enema exam (below right) shows an air filled colon with a large oval soft tissue mass in the cecum.
AXR supine (upper left) and coronal CT with contrast of the abdomen (lower left) show multiple dilated loops of small bowel with thin walls throughout the abdomen. The lower axial CT (upper right) shows a small cystic structure in the midline with a thicker wall than the surrounding dilated bowel which is also seen on the midline sagittal CT (lower right) just beneath the umbilicus.AXR AP (above left) shows multiple dilated loops of small bowel and a decomopressed colon. Coronal CT with contrast of the abdomen (above right) shows normal caliber and normal enhancement of the proximal jejunum loops in the left upper quadrant. The distal ileum loops in the right lower quadrant are dilated and do not enhance. There is pneumatosis intestinalis in the walls of the most lateral loop of ileum. Axial CT (below) again shows the pneumatosis in the walls of the most lateral loop of ileum on the right and again shows the difference in bowel wall enhancement between the normal jejunum on the left and the abnormal ileum on the right.
Surgical Cases of Small Bowel Obstruction Due to Meckel Diverticulum
Surgical image shows dilatation of almost the entire small bowel except for the decompressed terminal ileum in the left lower corner of the photograph. At this transition point, a diverticulum is noted on the anti-mesenteric border of the ileum.Surgical image shows shows multiple dilated loops of small bowel in the background with a sharp transition point seen in the center of the image in the terminal ileum where on its anti-mesenteric border a diverticulum is seen with an omphalomesenteric duct remnant coming off it. This remnant had been attached to the under surface of the umbilicus, serving as a fulcrum for a small bowel volvulus, resulting in a small bowel obstruction.Surgical image shows a closed loop small bowel obstruction caused by a small band of tissue (between the forceps) extending from small bowel to a purple in color Meckel diverticulum (center of image) arising from the antimesenteric border of the small bowel.Surgical image (above) shows an ileocolic intussusception which upon reduction is seen to be caused by a Meckel diverticulum (below in center of image with forceps pointing to it) on the antimesenteric border of the small bowel.Surgical image shows a dark and necrotic appearing distal ileum and a dark and necrotic appearing Meckel diverticum on the antimesenteric border of the bowel with a prominent vitelline artery (upper right corner of image) and volvulus of the adjacent intestine around it.Surgical image shows a dark and necrotic appearing distal ileum (left side of image) with a dark and necrotic Meckel diverticulum along the antimesenteric border of the bowel (upper image) causing an internal hernia and a closed loop small bowel obstruction with the necrotic distal ileum herniating through the band of the vitelline duct.
Radiology Cases of Small Bowel Obstruction Due to Cecal Volvulus
AXR AP taken immediately after an enema shows multiple dilated loops of air-filled small bowel with no reflux of contrast into the terminal ileum. The ascending colon ends in a beak which points to a dilated air-filled cecum in the right lower quadrant.
Surgical Cases of Small Bowel Obstruction Due to Cecal Volvulus
Surgical image shows an extremely distended cecum twisted around the pateint’s appendicovesicostomy tract. The distal ileum was also extremely dilated.
Radiology Cases of Small Bowel Obstruction Due to Ingested Rare Earth Magnets (Neodymium Magnets)
AXR shows multiple round and cylindrical radiopaque objects in the lower abdomen that are all in close approximation to each other. There are multiple dilated loops of small bowel present.
