Small Bowel Obstruction

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Small Bowel Obstruction

• Eduardo Lacayo
• 7/25/07

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• 1-month old male who was seen by his pediatrician
  with poor feeding and occasional emesis
• Birth history
• -29 wks Gestation
• -His birth weight was 2.9 kg
• Mother was a cocaine addict

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• On the third day of hospitalization, his emesis
  became bilious
• Radiographs of his abdomen were obtained

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Flat (supine) view
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Upright view
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• A barium enema was ordered
• An abdominal series was repeated prior to the
  barium enema

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Second abdominal series
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• During the process of inserting the rectal tube
  for the barium enema, the infant was crying and
  the radiologist noticed an inguinal bulge

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• The surgeons at this point acknowledged that the
  infant had an incarcerated right inguinal hernia
• Hernia was reduced with moderate difficulty
• Barium enema was then completed which failed to
  show any evidence of intussusception or
  malrotation
• The infant's symptoms resolved. A follow-up
  abdominal series taken the next morning showed a
  normal abdominal gas pattern with resolution of
  the obstruction

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SBO

• Small bowel obstruction is due to physical and
  organic changes which produce mechanical
  obstruction to the passage of the bowel contents
  somewhere in the small bowel

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Causes

• Themost common cause of a mechanical small bowel
  obstruction are adhesions related to prior
  surgery (60)
• -The most common prior surgeries associated with
  a subsequent SBO include appendectomy, colorectal
  surgery and gynecologic surgery
• Hernias
• -Femoral
• -Inguinal
• Intussusception
• Volvulus
• Tumor, either primary or metastatic
• Wall lesions such as leiomyomas or strictures
• Crohns disease

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Clinical Findings

• Abdominal pain and distension
• Nausea
• Vomiting
• Constipation
• History of prior abdominal or pelvic surgery
• Bowel sounds are hyperactive and high-pitched

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Imaging Findings

• Conventional radiography is the study of first
  choice
• Loops proximal to the point of obstruction will
  become dilated and fluid-filled
• -Usually greater than 2.5-3 cm in size
• Differential height of air-fluid levels in the
  same loop of small bowel no longer considered
  reliable sign of mechanical SBO
• Absence of, or disproportionately smaller amount
  of, gas in the colon, especially the rectosigmoid
• Loops of small bowel may arrange themselves in a
  step-ladder configuration from the left upper to
  the right lower quadrant in a distal SBO
• Mostly fluid-filled loops of bowel may
  demonstrate a string-of-beads sign caused by the
  small  amount of visible air in those loops

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CT of Small Bowel Obstruction
Axial CT scan through the lower abdomen
showsmultiple fluid-filled and dilated loops of
small bowel (white arrows) and collapsedright
colon (red arrow) consistent with a mechanical
small bowel obstruction.  
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References

• www.learningradiology.com
• http//www.hawaii.edu/medicine/pediatrics/pemxray/
  v3c16.html