eMedicine Specialties > Radiology > Gastrointestinal
Small-Bowel Obstruction: Multimedia
Updated: Sep 11, 2009
Multimedia
 | Media file 1: Plain abdominal radiograph in a 6-year-old boy who presented with vomiting and acute pain in the right iliac fossa. The loops of the small bowel are dilated, and associated with small calcific nodules in the right iliac fossa are seen. These findings are suggestive of appendicoliths. At laparotomy, an appendiceal mass was found; this caused the small-bowel obstruction. |
 | Media file 2: Plain abdominal radiograph in a 9-year-old patient with a past history of appendicitis complicated by peritonitis who presented with abdominal pain and vomiting. The clinical diagnosis was small-bowel obstruction resulting from adhesions. This radiograph shows markedly distended loops of small bowel, with effacement of the valvulae in the mid abdomen. The child recovered with conservative treatment. |
 | Media file 3: Lateral decubitus radiograph of a newborn who presented with features of bowel obstruction. The radiograph shows markedly distended loops of small bowel (same patient as in Image 4 in Multimedia). |
 | Media file 4: Plain abdominal radiograph of the abdomen in a newborn after 10 days of conservative treatment (same patient as in Image 3 in Multimedia). The radiograph shows only mild dilatation of the loops of the small bowel. Note the fine grainy calcification in the right iliac fossa. Meconium peritonitis (arrow), caused by the small-bowel obstruction, was diagnosed. |
 | Media file 5: An erect plain abdominal radiograph in a 4-year-old patient from a region in which roundworms are known to be endemic. The radiograph shows multiple dilated loops of small bowel, with air-fluid levels and tangled roundworms (arrow). |
 | Media file 6: This plain abdominal radiograph of a 55-year-old woman presenting with features of intestinal obstruction shows dilated loops of the small bowel associated with thickened edematous valvulae conniventes and a strangulated left inguinal hernia (arrow). |
 | Media file 7: Plain abdominal radiograph of the abdomen in a 72-year-old man with a history of intermittent abdominal pain over several years that settled spontaneously. On this occasion, his pain was severe. The abdominal radiograph shows dilated loops of small bowel, but the concentration of several loops of small bowel in the right hypochondrium should be noted as this finding is suggestive of malrotation. At surgery, a midgut volvulus caused by malrotation was found. The patient's age is unusual for those presenting with a midgut volvulus. |
 | Media file 8: An upper GI barium series in a 32-year-old man with a history of intermittent small-bowel volvulus that lasted several years and settled spontaneously. The barium study shows the jejunal loops in the right hypochondrium; this finding is suggestive of bowel malrotation. |
 | Media file 9: An erect plain abdominal radiograph of the abdomen in a 72-year-old woman that shows markedly distended jejunal loops with air-fluid levels. The air overlying the liver and a large laminated gallstone in the right iliac fossa (arrow) should be noted. The features are those of a gallstone ileus. |
 | Media file 10: Plain abdominal radiograph of the abdomen in a 52-year-old woman presenting with features of small-bowel obstruction. At laparotomy, a cecal volvulus was found to be the cause of the obstruction. Note that the cecum occupies the middle of the abdomen and that the cecal pole is directed laterally. |
 | Media file 11: A plain abdominal radiograph of the abdomen in a 36-year-old man shows features of mid small-bowel obstruction caused by a paraumbilical hernia (arrow). |
 | Media file 12: An upper GI barium study performed through a nasogastric tube in a patient with clinical features of bowel obstruction but a gasless abdomen on plain abdominal radiograph. The barium study shows a fistulous communication between the gallbladder fossa and the duodenum and marked dilatation of the jejunum associated with stretched mucosal folds. At laparotomy, a gallstone ileus was confirmed. |
 | Media file 13: Erect plain abdominal radiograph of the abdomen in a 69-year-old woman presenting with features of small-bowel obstruction. Radiograph shows air in the biliary tree, a string-of-beads sign (arrows), and a faint opacity in the right lower pelvis suggestive of a gallstone (not depicted well; same patient as in Images 14-15 in Multimedia). |
 | Media file 14: An upper GI barium series performed via a nasogastric tube in a 69-year-old woman presenting with features of small-bowel obstruction showing reflux of barium into the biliary tree and the gallbladder fossa (same patient as in Images 13-15 in Multimedia). Note the mild dilatation of the duodenum. |
 | Media file 15: Follow-up barium study in the small bowel of a 69-year-old woman presenting with features of small-bowel obstruction (same patient as in Images 13-14 in Multimedia) showing obstruction caused by a large laminated gallstone (arrow). |
 | Media file 16: Water-soluble contrast upper GI examination in a patient with clinical features of small-bowel obstruction and a history of surgery for large bowel cancer. The contrast-enhanced study shows dilated loops of small bowel, with stretching of the mucosal folds and a narrowed segment ending in a beak (arrow). At surgery, a small-bowel obstruction from extrinsic compression was found to be the result of mesenteric metastases. |
 | Media file 17: Plain abdominal radiograph of the abdomen in a 53-year-old woman with Crohn disease who presented with features of small-bowel obstruction. The radiograph shows a long stricture of the terminal ileum. |
 | Media file 18: Upper GI barium series in a patient with features of intermittent small-bowel obstruction. Multiple strictures and polypoid filling defects are noted in the proximal small bowel caused by deposits of non-Hodgkin lymphoma. |
 | Media file 19: Plain abdominal radiograph of the abdomen in a 47-year-old man presenting with features of small-bowel obstruction. The radiograph shows markedly dilated loops of small bowel in the central and upper abdomen, with little air seen in the colon (same patient as in Images 20-21 in Multimedia). |
 | Media file 20: An erect plain abdominal radiograph in a 47-year-old man presenting with features of small-bowel obstruction. The image shows multiple fluid levels in the small bowel (same patient as in Images 19-21 in Multimedia). |
 | Media file 21: Postevacuation image from part of a double-contrast barium enema study in a 47-year-old man presenting with features of small-bowel obstruction. The image shows a coiled-spring appearance in the region of the cecum suggestive of an intussusception (same patient as in Images 19-20 in Multimedia). At laparotomy, an ileocecal intussusception was found in association with a carcinoid tumor of the terminal ileum. |
 | Media file 22: An erect abdominal image obtained as part of a double-contrast barium enema study shows multiple fluid levels in the centrally placed small bowel (same patient as in Image 23 in Multimedia). |
 | Media file 23: A radiograph of the terminal ileum showing a stricture and shouldering of the terminal ileum caused by an adenocarcinoma (same patient as in Image 22 in Multimedia). |
 | Media file 24: A supine abdominal radiograph in a 57-year-old man presenting with colicky abdominal pain and vomiting that shows multiple dilated loops of small bowel in the central abdomen and a possible mass in the right hypochondrium (same patient as in Image 25 in Multimedia). |
 | Media file 25: Postevacuation image from part of a barium enema study in a 57-year-old man presenting with colicky abdominal pain and vomiting. The image shows a coiled-spring appearance at the hepatic flexure of the colon typical of an intussusception (same patient as in Image 24 in Multimedia). At laparotomy, an ileocolic intussusception was found; this was secondary to a carcinoid tumor of the terminal ileum. |
 | Media file 26: A sonogram of the right iliac fossa in a 2-year-old child presenting with abdominal pain that shows a bowel mass demonstrated as the pseudokidney sign (same patient as in Image 27 in Multimedia). |
 | Media file 27: Part of a barium enema study in a 2-year-old child presenting with abdominal pain showing a polypoid filling defect within the ascending colon (same patient as in Image 26 in Multimedia). The filling defect was constant on all images. At laparotomy, a chronic ileocolic intussusception was found. |
 | Media file 28: Abdominal sonogram in a 16-year-old male adolescent with cystic fibrosis who presented with intermittent colicky epigastric pain of 6 weeks' duration. The sonogram shows a complex mass of concentric rings of alternating hypoechoic and hyperechoic layers surrounding a highly reflective center. The mass was located in the epigastrium (same patient as in Image 29 in Multimedia). |
 | Media file 29: A nonenhanced CT scan of the abdomen in a 16-year-old male adolescent with cystic fibrosis who presented with intermittent colicky epigastric pain of 6 weeks' duration. The scan shows a complex mass of concentric rings of alternating low- and high-attenuating layers surrounding a very high attenuation center caused by intraluminal Gastrografin (same patient as in Image 28 in Multimedia). At laparotomy, a chronic jejunojejunal intussusception was found. |
 | Media file 30: A CT scan of a 36-year-old woman with Gardner syndrome presented with features of small-bowel obstruction. The axial contrast-enhanced CT scan through the midabdomen shows an extrinsic mass compressing a loop of small bowel. At laparotomy, a desmoid tumor of the mesentery was found; this caused the small-bowel obstruction. |
 | Media file 31: A supine abdominal radiograph of a 47-year-old man who presented with intermittent abdominal pain and weight loss of 3 months' duration. The radiograph shows mildly dilated loops of small bowel. Note the air in the transverse colon; this can be traced to the rectum (same patient as in Image 32 in Multimedia). |
 | Media file 32: A contrast-enhanced axial CT scan through the midabdomen showing a marked mural thickening associated with mucosal irregularity at the hepatic flexure of the colon. At laparotomy, a carcinoma was found; this involved the ascending colon and hepatic flexure. |
 | Media file 33: A plain abdominal radiograph of a 67-year-old man who presented with features of small-bowel obstruction. The radiograph demonstrates gasless findings (same patient as in Image 34 in Multimedia). |
 | Media file 34: A nonenhanced CT scan at the level of the umbilicus in a 67-year-old man who presented with features of small-bowel obstruction. The scan shows dilated loops of fluid-filled small bowel, with a small amount of air (same patient as in Images 33-35 in Multimedia). Note the collapsed right colon and beak-shaped transition of the small bowel (arrow). |
 | Media file 35: A nonenhanced transaxial CT scan at the level of the umbilicus in a 67-year-old man who presented with features of small-bowel obstruction. The scan shows a dilated loop of air-fluid–filled small bowel leading into an incarcerated umbilical hernia (same patient as in Images 33-34 in Multimedia). |
 | Media file 36: Enhanced axial CT scan of the mid abdomen in a 67-year-old woman. The scan shows a dilated loop of small bowel with a beak-shaped cutoff (same patient as in Image 37 in Multimedia). |
 | Media file 37: An enhanced axial CT scan at the level of the pelvic brim in a 67-year-old woman. The scan shows a gallstone obstructing the small bowel (same patient as in Image 36 in Multimedia). |
 | Media file 38: A Barium follow-through study in a 63-year-old woman who presented with features of recurrent attacks of small-bowel obstruction that shows mucosal edema and stricturing of the terminal ileum and the cecum (same patient as in Images 39-40 in Multimedia). |
 | Media file 39: An enhanced axial CT scan at the level of the right iliac fossa in a 63-year-old woman who presented with features of recurrent attacks of small-bowel obstruction. The scan shows transmural thickening of the terminal ileum associated with mucosal irregularity (same patient as in Images 38-40 in Multimedia). |
 | Media file 40: Technetium-99m hexamethylpropyleneamine oxime (99mTc HMPAO)–labeled white blood cell scan in a 63-year-old woman who presented with features of recurrent attacks of small-bowel obstruction. The scan shows active uptake of the radionuclide in the terminal ileum and the cecum/ascending colon indicative of an active inflammatory process (same patient as in Images 38-39 in Multimedia). The patient was treated for active Crohn disease. |
 | Media file 41: This abdominal radiograph (left) shows a dilated loop of small bowel in the mid abdomen (hollow arrow). There is a soft tissue density overlying the left pubic bone, with a vague air density suggestive of an inguinal hernia. An axial CT scan confirms the presence of fat density within the scrotum. At surgery, a nonstrangulated small-bowel loop was released from the left inguinal canal. |
More on Small-Bowel Obstruction |
| Overview: Small-Bowel Obstruction |
| Imaging: Small-Bowel Obstruction |
| Follow-up: Small-Bowel Obstruction |
 Multimedia: Small-Bowel Obstruction |
| References |
| Further Reading |
| « Previous Page |
References
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Further Reading
Clinical guidelines
Suspected small bowel obstruction.
American College of Radiology. 1996 (revised 2005). 5 pages. NGC:004782
Practice management guidelines for small bowel obstruction.
Eastern Association for the Surgery of Trauma - Professional Association. 2007. 42 pages. NGC:006546
Clinical trials
Value of CT-Scan and Oral Gastrografin in the Management of Post Operative Small Bowel Obstruction
Related eMedicine topics
Small-Bowel Obstruction (Pediatrics: General Medicine)
Obstruction, Small Bowel
Small Intestinal Atresia and Stenosis
Keywords
small bowel obstruction, small-bowel obstruction, partial small bowel obstruction, bowel obstruction, intestinal obstruction, bowel blockage, gastric obstruction, partial bowel obstruction, obstructed bowel, SBO, mechanical ileus, mechanical small bowel obstruction, ileus, bezoar, foreign body obstruction, food bolus obstruction, bowel wall lesional obstruction, bowel stricture, volvulus, hernia, bowel adhesion
