IMAGING MODALITIES   IN INTESTINAL   OBSTRUCTION      By – MITHLESH KUMAR Third Professional MBBS Part – II     Medical Co...
OVERVIEW•   Radiography•   Computed Tomography•   Magnetic Resonance Imaging•   Ultrasonography•   Nuclear Imaging•   Angi...
Radiography• Plain upright abdominal X – Ray• Conventional barium follow – through  examination and enteroclysis• Barium e...
Radiological features of plain X - Ray• Small bowel – straight segments generally central  and lie transversely• Jejunum –...
Some special points• In intestinal obstruction fluid level appear later than gas shadow as it takes  time for gas and flui...
Supine view of the abdomen in a patient with intestinal obstruction.Dilated loops of small bowel are visible(arrows)
Upright view of abdomen in a patient with intestinal obstruction,Showing multiple air fluid levels
Lateral decubitus view of abdomen, showing air fluid levels consistentwith intestinal obstruction (arrows)
Plain abdominal radiograph shows dilated loops of small bowelassociated with thickened edematous valvulae conniventes
Barium follow - through     Following features may assist in diagnosis •   Delay in the transit time •   Snakehead appeara...
The contrast enhanced study shows dilated loops of small bowel withstretching of the mucosal folds and a narrowed segment ...
Enteroclysis      Divide small bowel obstruction into 3 groups• Low – grade or incomplete obstruction• High – grade obstru...
Barium enema study• Useful in large bowel obstruction• In children with intussusception it is  diagnostic as well as thera...
Postevacuation image from part of a barium enema study, shows a coiledspring appearance at the hepatic flexure of the colo...
Computed Tomography• Recommended when initial clinical findings  and plain radiographs are inconclusive• When strangulatio...
Axial computed tomography scan showing dilated, contrast filled loops ofthe bowel on the patient’s left( yellow arrows), w...
Magnetic Resonance Imaging• Assessment of small – bowel obstruction with  strangulation
Ultrasonography• It is of particular value in looking at the  dynamics of the small bowel• Used to assess peristalsis
A sonogram of right iliac fossa shows a bowel mass
Nuclear Imaging• White blood scanning for detection and  localization of intra abdominal inflammatory  disease
99mTc HMPAO labeled white blood cell scan shows active uptake of theradionuclide in the terminal ileum and caecum/ascendin...
Angiography• Superior mesenteric angiography used in  diagnosis of internal  herniation, intussusception, volvulus, malrot...
Imaging in Intussusception• Plain abdominal X – Ray shows features of  small and large bowel obstruction• Barium follow th...
‘Claw ‘sign of iliac intussusception , the barium in the intussusception isseen as a claw around a negative shadow of the ...
Postevacuation image from part of a barium enema study shows a coiledspring appearance in the region of caecum suggestive ...
Imaging in VolvulusCaecal volvulus – bird beak deformity in barium enemaSigmoid volvulus – dilated loop
Grossly dilated loop of bowel in the central abdomen with the ends ofthe loop pointing towards the right half of the pelvis
Shows a medially pointed end column of the barium (beak sign) in themid ascending colon
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Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College kolkata

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Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College kolkata

  1. 1. IMAGING MODALITIES IN INTESTINAL OBSTRUCTION By – MITHLESH KUMAR Third Professional MBBS Part – II Medical College Kolkata
  2. 2. OVERVIEW• Radiography• Computed Tomography• Magnetic Resonance Imaging• Ultrasonography• Nuclear Imaging• Angiography
  3. 3. Radiography• Plain upright abdominal X – Ray• Conventional barium follow – through examination and enteroclysis• Barium enema study
  4. 4. Radiological features of plain X - Ray• Small bowel – straight segments generally central and lie transversely• Jejunum – valvulae conniventes, spaced regularly, concertina or ladder effect• Ileum – featureless• Caecum – rounded gas shadow in right iliac fossa• Large bowel except caecum – haustral folds, spaced irregularly
  5. 5. Some special points• In intestinal obstruction fluid level appear later than gas shadow as it takes time for gas and fluid to separate• In adults, two inconstant fluid levels – one at the duodenal cap and the other in the terminal ileum may be regarded as normal• In infants fluid levels in small bowel may be physiological, in this age group it is difficult to distinguish large from small bowel in the presence of obstruction because the characteristic features seen in adults are not present or are unreliable• In small bowel the number of fluid levels is directly proportional to the degree of obstruction and to its site, the number increasing the more distal the lesion• Limited water soluble enema differentiates large bowel obstruction from pseudo-obstruction
  6. 6. Supine view of the abdomen in a patient with intestinal obstruction.Dilated loops of small bowel are visible(arrows)
  7. 7. Upright view of abdomen in a patient with intestinal obstruction,Showing multiple air fluid levels
  8. 8. Lateral decubitus view of abdomen, showing air fluid levels consistentwith intestinal obstruction (arrows)
  9. 9. Plain abdominal radiograph shows dilated loops of small bowelassociated with thickened edematous valvulae conniventes
  10. 10. Barium follow - through Following features may assist in diagnosis • Delay in the transit time • Snakehead appearance • Beak sign • Fixation and kinking
  11. 11. The contrast enhanced study shows dilated loops of small bowel withstretching of the mucosal folds and a narrowed segment ending in a beak(arrow)
  12. 12. Enteroclysis Divide small bowel obstruction into 3 groups• Low – grade or incomplete obstruction• High – grade obstruction• Complete small – bowel obtruction
  13. 13. Barium enema study• Useful in large bowel obstruction• In children with intussusception it is diagnostic as well as therapeutic
  14. 14. Postevacuation image from part of a barium enema study, shows a coiledspring appearance at the hepatic flexure of the colon typical of anintussusception
  15. 15. Computed Tomography• Recommended when initial clinical findings and plain radiographs are inconclusive• When strangulation is suspected• Clearly demonstrate abnormalities of bowel wall, mesentery, mesenteric vessels, peritoneum• Should be performed with intravenous contrast enhancement
  16. 16. Axial computed tomography scan showing dilated, contrast filled loops ofthe bowel on the patient’s left( yellow arrows), with decompressed distalsmall bowel on the patient’s right(red arrows)
  17. 17. Magnetic Resonance Imaging• Assessment of small – bowel obstruction with strangulation
  18. 18. Ultrasonography• It is of particular value in looking at the dynamics of the small bowel• Used to assess peristalsis
  19. 19. A sonogram of right iliac fossa shows a bowel mass
  20. 20. Nuclear Imaging• White blood scanning for detection and localization of intra abdominal inflammatory disease
  21. 21. 99mTc HMPAO labeled white blood cell scan shows active uptake of theradionuclide in the terminal ileum and caecum/ascending colonindicative of an active inflammatory process
  22. 22. Angiography• Superior mesenteric angiography used in diagnosis of internal herniation, intussusception, volvulus, malrotat ion, and adhesions.
  23. 23. Imaging in Intussusception• Plain abdominal X – Ray shows features of small and large bowel obstruction• Barium follow through of ileocolic intussusception shows claw sign• Abdominal ultrasonography demonstrate doughnut appearance
  24. 24. ‘Claw ‘sign of iliac intussusception , the barium in the intussusception isseen as a claw around a negative shadow of the intussusception
  25. 25. Postevacuation image from part of a barium enema study shows a coiledspring appearance in the region of caecum suggestive intussusception
  26. 26. Imaging in VolvulusCaecal volvulus – bird beak deformity in barium enemaSigmoid volvulus – dilated loop
  27. 27. Grossly dilated loop of bowel in the central abdomen with the ends ofthe loop pointing towards the right half of the pelvis
  28. 28. Shows a medially pointed end column of the barium (beak sign) in themid ascending colon

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