Skip main navigation
Close Drawer MenuOpen Drawer Menu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
Menu
  • Information
    • Previous
    Next
    Review

    Small-Bowel Obstruction: Optimizing Radiologic Investigation and Nonsurgical Management

    Published Online:Jan 1 2001https://doi.org/10.1148/radiology.218.1.r01ja5439

    Abstract

    Small-bowel obstruction is an old and common problem. Like most illnesses, its diagnosis and treatment continue to evolve. The radiologic approach to the investigation of small-bowel obstruction and the timing of surgical intervention have undergone considerable changes during the past decade. In this review, the authors analyze the recently described radiologic techniques used in the examination of patients with suspected mechanical small-bowel obstruction, revisit the controversy of the short versus long decompression tube, and provide insights on how to optimize the radiologic investigation and nonsurgical management of small-bowel obstruction.

    References

    • 1 Maglinte DDT, Balthazar EJ, Kelvin FM, Megibow AJ. The role of radiology in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol 1997; 168:1171-1180. Crossref, Medline, Google Scholar
    • 2 Siewert B, Raptopoulos V. CT of the acute abdomen: findings and impact on diagnosis and treatment. AJR Am J Roentgenol 1994; 163:1317-1324. Crossref, Medline, Google Scholar
    • 3 Balthazar EJ, Birnbaum BA, Megibow AJ, et al. Closed loop and strangulating intestinal obstruction: CT signs. Radiology 1992; 185:769-775. Link, Google Scholar
    • 4 Balthazar EJ. CT of small bowel obstruction. AJR Am J Roentgenol 1994; 162:255-261. Crossref, Medline, Google Scholar
    • 5 Megibow AJ, Balthazar EJ, Cho KC, et al. Bowel obstruction: evaluation with CT. Radiology 1991; 180:313-318. Link, Google Scholar
    • 6 Fukuya T, Hawes DR, Lu CC, et al. CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol 1992; 158:765-772. Crossref, Medline, Google Scholar
    • 7 Maglinte DDT, Gage S, Harmon B, et al. Obstruction of the small intestine: accuracy and role of CT in diagnosis. Radiology 1993; 186:61-64. Google Scholar
    • 8 Bender GN, Maglinte DDT, Kloppel VR, Timmons JH. CT enteroclysis: is it another superfluous diagnostic procedure or does it have a role in the investigation of small bowel disease?. AJR Am J Roentgenol l999; 172:373-378. Crossref, Medline, Google Scholar
    • 9 Morgenstern L. Whatever happened to the long tube?. Am J Surg 1995; 170:237. Crossref, Medline, Google Scholar
    • 10 Otamiri T, Sjodahl R, Ihse I. Intestinal obstruction with strangulation of the small bowel. Acta Chir Scand 1987; 153:307-310. Medline, Google Scholar
    • 11 Seror D, Feigin E, Szold A, et al. How conservatively can postoperate small bowel obstruction be treated?. Am J Surg 1993; 165:121-126. Crossref, Medline, Google Scholar
    • 12 Welch JP. General consideration and mortality in bowel obstruction. In: Welch JP, eds. Bowel obstruction: differential diagnosis and clinical management. Philadelphia, Pa: Saunders, 1990; 59-95. Google Scholar
    • 13 Mucha P, Jr. Small intestinal obstruction. Surg Clin North Am 1987; 67:597-620. Crossref, Medline, Google Scholar
    • 14 Osteen RT, Guyton S, Steele G, Jr, Wilson RE. Malignant intestinal obstruction. Surgery 1980; 87:611-615. Medline, Google Scholar
    • 15 1991; 22:686. Google Scholar
    • 16 Paine JR. The hydro-dynamics of the relief of distention in the gastrointestinal tract by suction applied to inlaying catheters. Arch Surg 1936; 33:995-1020. Crossref, Google Scholar
    • 17 Cantor MO. Intestinal decompression tubes in use today. In: Cantor MO, eds. Intestinal intubation. Springfield, Ill: Thomas, 1949; 100-115. Google Scholar
    • 18 Gowen GF, DeLaurentis DA, Stefan MM. Immediate endoscopic placement of long intestinal tube in partial small bowel obstruction. Surg Gynecol Obstet 1987; 165:456-458. Medline, Google Scholar
    • 19 Fleshner PR, Siegman MG, Slater GI, et al. A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction. Am J Surg 1995; 170:366-370. Crossref, Medline, Google Scholar
    • 20 Adams MB, Condon RE. Fluid and electrolyte therapy. In: Condon RE, Nyhus LM, eds. Manual of surgical therapeutics. 5th ed. Boston, Mass: Little, Brown, 1981; 171-202. Google Scholar
    • 21 Gowen GF, Aufses A. Short versus long tubes (letter). Am J Surg 1996; 171:543-544. Crossref, Google Scholar
    • 22 McGaig LF, Stussman BJ. National Hospital Ambulatory Medical Care survey: 1996 Emergency Department summary—advanced data from vital health statistics, no. 293. DHSS Publication no. (PHS) Hyattsville, Md: National Center for Health Statistics, 1997; 98-1250. Google Scholar
    • 23 Hunter TB, Gon GT, Silverman ME. Complications of intestinal tubes. Am J Gastroenterol 1981; 76:246-251. Medline, Google Scholar
    • 24 Singer AJ, Richman PB, La Vefre R, et al. Comparison of patient and practitioner’s assessment of pain from commonly performed emergency department procedures (abstr). Acad Emerg Med 1997; 4:404. Google Scholar
    • 25 Maglinte DDT, Cordell WH. Strategies for reducing the pain and discomfort of nasogastric intubation. Acad Emerg Med 1999; 6:166-169. Crossref, Medline, Google Scholar
    • 26 Maglinte DDT, Lappas JC, Chernish SM, et al. Improved tolerance of enteroclysis by use of sedation. AJR Am J Roentgenol 1988; 151:951-952. Crossref, Medline, Google Scholar
    • 27 Maglinte DDT, Kelvin FM, Micon LT, et al. Nasointestinal tube for decompression or enteroclysis: experience with 150 patients. Abdom Imaging 1994; 19:108-112. Crossref, Medline, Google Scholar
    • 28 Maglinte DDT, Stevens LH, Hall RC, et al. Dual-purpose tube for enteroclysis and nasogastric-nasoenteric decompression. Radiology 1992; 185:281-282. Link, Google Scholar
    • 29 Shrake PD, Rex DK, Lappas JC, Maglinte DDT. Radiographic evaluation of suspected small-bowel obstruction. Am J Gastroenterol 1991; 86:175-178. Medline, Google Scholar
    • 30 Makanjuola D. Computed tomography compared with small bowel enema in clinically equivocal intestinal obstruction. Clin Radiol 1998; 53:203-208. Crossref, Medline, Google Scholar
    • 31 Kloppel Von R, Thiele J, Bosse J. The Sellink CT method. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1992; 156:291-292[German]. Crossref, Google Scholar
    • 32 Bender GN, Timmons JH, Williard WC, Carter J. Computed tomographic enteroclysis: one methodology. Invest Radiol 1996; 31:43-49. Crossref, Medline, Google Scholar
    • 33 Walsh DW, Bender GN, Timmons JH. Comparison of computed tomography: enteroclysis and traditional computed tomography in the setting of suspected partial small bowel obstruction. Emerg Radiol 1998; 5:29-37. Crossref, Google Scholar
    • 34 Freys SM, Fuchs KH, Meimbucher J, Thiede A. Laparoscopic adhesiolysis. Surg Endosc 1994; 8:1202-1207. Crossref, Medline, Google Scholar
    • 35 Bender GN, Maglinte DDT. Small bowel obstruction: the need for greater radiologist involvement. Emerg Radiol 1997; 4:337-339. Crossref, Google Scholar
    • 36 Frager D, Baer JW, Medwid SW. Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT. AJR Am J Roentgenol 1996; 166:67-71. Crossref, Medline, Google Scholar
    • 37 Cho KC, Hoffman-Tretin JC, Alterman DD. Closed-loop obstruction of the small-bowel: CT and sonographic appearance. J Comput Assist Tomogr 1989; 13:256-258. Crossref, Medline, Google Scholar
    • 38 Ha HK, Park CH, Kim SK, et al. CT analysis of intestinal obstruction due to adhesions: early detection of strangulation. J Comput Assist Tomogr 1993; 17:386-389. Crossref, Medline, Google Scholar
    • 39 Jaramillo D, Raval B. CT diagnosis of primary small-bowel volvulus. AJR Am J Roentgenol 1986; 147:941-942. Crossref, Medline, Google Scholar
    • 40 Fisher JK. Computed tomographic diagnosis of volvulus in intestinal malrotation. Radiology 1981; 140:145-146. Link, Google Scholar
    • 41 Taourel PG, Fabre VM, Pradel JA, et al. Value of CT in diagnosis and management of patients with suspected acute small-bowel obstruction. AJR Am J Roentgenol 1995; 165:1187-1192. Crossref, Medline, Google Scholar
    • 42 Gazelle GS, Goldberg MA, Wirttenberg J, et al. Efficacy of CT in distinguishing small-bowel obstruction from other causes of small-bowel dilatation. AJR Am J Roentgenol 1994; 162:43-47. Crossref, Medline, Google Scholar
    • 43 Frager D, Medwid SW, Baer JW, et al. CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree of cause. AJR Am J Roentgenol 1994; 162:37-41. Crossref, Medline, Google Scholar
    • 44 Maglinte DDT, Kelvin FM, O’Connor K, et al. Current status of small bowel radiography. Abdom Imaging 1996; 21:247-257. Crossref, Medline, Google Scholar

    Article History

    Published in print: Jan 2001