Small Bowel Obstruction

Bondoc, John Benedict V.

FEU-NRMF Clinical Clerk M18
“Acute Abdomen Series”
• Erect posterior-anterior chest radiograph
• Supine abdominal radiograph
• Erect or decubitus abdominal radiograph
Normal Abdominal Gas Pattern
• Normal Air Fluid levels
• Seen in stomach and small bowel
• Not exceed 2.5 cm in length in small
bowel
• Small bowel gas
• Appears as multiple small, random gas
collection scattered throughout the
abdomen
• Normal pattern: varies from no
intestinal gas to gas within 3-4 variable
shaped intestinal loops measuring less
than 2.5 to 3 cm in diameter
Mechanical Bowel Obstruction
• Stasis of bowel contents above focal lesion

• Causes:
• Obturation (occlusion by a mass in the lumen)
• Stenosis (due to intrinsic bowel disease)
• Compression of the lumen (by extrinsic disease)
Goal of Imaging
• Confirm the presence of obstruction
• Identify it level
• Demonstrate its cause
Radiographs
• Can confirm the presence of bowel obstruction 6 to 12 hours before
the diagnosis can usually be made by clinically
Variety of terms
• Complete obstruction – lumen is totally occluded
• Partial obstruction – some bowel contents pass through

• Simple obstruction – refers to blockage of the luminal contents

without interference of blood supply
• Strangulation obstruction – means that the blood supply to the bowel
is impaired

• Closed loop obstruction – blockage of a bowel loop segment at both

ends
 Clinical
Presentation
• Crampy abdominal pain
• Abdominal distention
• Vomiting
Finding of SBO in Radiographs
1. Dilated loops of small bowel (>3cm) disproportionate to more distal
small bowel
2. Small bowel air-fluid levels that exceed 2.5 cm in width
3. Air-fluid levels at differing heights (>5mm) within the same loop –
“dynamic air fluid levels”
4. Two or more air-fluid levels
5. Small bubbles of gas trapped between folds in dilated, fluid-filled
loops producing the “string of pearls” sign
6. Stepladder sign
Slit/Stretch
Sign
• is a result of
small amounts
of air caught in
the valvulae of
fluid-filled
bowel
CT Scan
• Imaging method of choice to confirm small bowel obstruction and to
identify its cause
• Reveals the cause of obstruction in 70% - 90% of cases
• CT diagnosis: demonstration of a transition site between small bowel
loops dilated with fluid or air and collapsed bowel loops distal to the
obstruction
• Strings of Pearls sign
• Small-Bowel Feces sign
THE END