Bowel obstruction X-ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

An X-ray is the initial investigation performed in the diagnosis of bowel obstruction. Findings on an X-ray suggestive of bowel obstruction include dilated bowel loops with air-fluid level, distal collapsed bowel, absence of gas in the abdomen or alternatively, "string of pearls" sign indicating trapped flatus.

X Ray

• A plain X-ray is recommended as the initial investigation of choice when bowel obstruction is suspected.
• The X-ray should be performed when:
  • The patient is suspected of needing intervention and presents with symptoms of obvious distress, nausea, vomiting, abdominal distension, abdominal pain and constipation.
• The following result of plain X-ray is confirmatory of bowel obstruction:
  • Dilated bowel loops with air-fluid level
    • In the supine postion, an estimate of bowel distension is made based on the width of the bowel loops
    • In the lateral postion, air fluid levels are seen more clearly
  • Distal collapsed bowel
    • Small bowel obstruction must cause a dilation of more than 2.5cm to be visible on X-ray
  • Gasless abdomen or alternatively, "string of pearls" sign
    • A "gasless abdomen" indicates that the bowel loop is filled with fluid with no room for gas to occupy the bowel loop
    • "String of pearls" sign indicates that a bowel loop is partially filled with fluid and that air bubbles are accumulating along the surface

X-ray in the upright position demonstrating multiple fluid levels in bowel obstruction by James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8384519

Limitations of plain X-ray

• The site and etiology of obstruction usually cannot be determined especially in the area between the dilated proximal and the nondilated distal loop of the small bowel.
• It is also limited in distinguishing small from large bowel impactions.
• X-rays are not sensitive in differentiating partial obstructions from paralytic ileus.

The comparison table for diagnostic studies of choice for bowel obstruction

	Sensitivity	Specificity
CT	93%	100%
X-ray	50%	75%

References

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