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VETERINARY MEDICAL IMAGING IMAGERIE EN MEDECINE VETERINAIRE

I

The obstructive bowel pattern: An inconsistent

radiographic sign of obstruction
Charles S. Farrow
During the past year, I have heard the expression,
obstructive bowel pattern, used with increasing
frequency by house officers at the Western College of
Veterinary Medicine. Inquiring as to its meaning, I am
told it is used to describe a distended intestine that
contains an excessive amount of gas. Advocates believe
this pattern implies a need for surgical treatment.
I would like to examine the validity of such thinking
in light of my own experience and with a case example.
I was called in at midnight to look at the radiographs
of a young male Rottweiler that the attending intern
believed had an intestinal obstruction indicated by the
presence of an obstructive bowel pattern.
Concurring 2nd opinions by an internist and a surgeon
prompted the making of barium radiographs, which
started just before my arrival.
Plain radiographs of the abdomen showed increased Figure 1. Lateral abdominal radiograph of a vomiting dog
abdominal density and reduced organ detail. Most of the showing what was described as "obstructive bowel pattern."
bowel was distended with fluid, and centrally there
were half a dozen, moderately dilated, gas-filled, bowel pseudofluid produced by many, closely approxi-
segments, 1 of which appeared to be the cecum. No mated, large, fluid-filled, bowel segments.
extravisceral air was present (Figures 1, 2). Early barium * A mass effect, as usually seen with a medium- to
radiographs showed normal gastric emptying. large-sized intussusception, was not present, although
Sonography showed most of the small intestine to be reduced abdominal detail could account for this fact.
dilated and fluid-filled (Figure 3). Intestinal contractions,
primarily bidirectional mixing waves, were observed and Sonograms
interpreted as excessive in both force and frequency, * As with the radiographs, the distended bowel sug-
but no obstruction or displacement was noted. An esti- gested obstruction, but no cause was identified.
mated 500 mL of clear fluid was evenly distributed * The bowel, as judged by the force and frequency of its
throughout the peritoneal cavity. contractions, was hypertonic, thus excluding paralytic
Later barium radiographs showed moderate dilation obstruction (ileus).
of the small intestine, excluding most of the duode- * Lack of radiographic detail appeared to be the result
num which was only mildly distended. My explana- of a medium volume of peritoneal fluid, combined
tion of the described images was as follows: with a fluid-distended bowel.
Radiographs Barium radiographs
* Widespread, marked, fluid-distension of the intestine * There was neither gastric or intestinal blockage, nor
was compatible with obstruction, but it may also be evidence of bowel displacement.
observed with infectious or inflammatory bowel dis- * Most of the bowel was dilated.
ease, particularly canine parvoviral enteritis (1). * The barium reached the caudal part of the small
* The increase in abdominal density and the reduced intestine in less time than normal.
organ detail were likely due to peritoneal fluid or
Conclusion
* No mechanical cause for the radiographically
Department of Veterinary Anesthesiology, Radiology and and sonographically observed intestinal distension
Surgery, Western College of Veterinary Medicine, University was found; nor was there any indication of bowel
of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan atony. Thus, enteritis was a more likely cause than
S7N 5B4. obstruction.
Can Vet J Volume 38, May 1997 309
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Figure 3. Close-up sonogram showing intestinal fluid dis-

tension in the dog seen in Figures I and 2.

Relating distension to obstruction and, in turn, to a

KR
need for surgical correction appears to be closely linked
to the so-called obstructive bowel pattern, and this is
where the reasoning becomes fuzzy.
Patterns, as used in radiology, are typically com-
posed of 2 or more abnormalities that consistently
appear together and have a known probable cause. For
example, cardiomegaly and pulmonary hyperemia occur-
ring in an older dog with a heart murmur are most apt to
be the result of endocardiosis of I or both atrioven-
tricular valves, particularly the mitral valve.
Bowel distension on the other hand, with or without
gas, is merely a radiographic sign, not a pattern - at least
Figure 2. Ventrodorsal abdominal radiograph of the same in the generally accepted use of the word. In my expe-
dog seen in Figure 1. rience, bowel distension is more likely to be the result of
enteritis or atony than obstruction of whatever cause.
Outcome Perhaps even more thought provoking in this case is
Based on surgical intuition, the dog was operated on and the issue of surgical intuition overriding factual evidence.
found to have a dilated, hyperemic bowel, compatible When should this be done, and when is it dangerous?
with enteritis. I will leave you to consider this question, and will take
it up in a future column. In the meantime, I strongly
Clinical lesson recommend that the term "obstructive bowel pattern"
All that glitters is not gold, and all that is distended is not be abandoned.
obstructed.
This case vividly illustrates the perils of ascribing a References
generalized distension of the small intestine to obstruc- 1. Farrow CS. Radiographic appearance of canine parvoviral enteri-
tion, even after extensive diagnostic imaging to the tis. J Am Vet Med Assoc 1982; 180: 43-47.
contrary.

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310 Can Vet J Volume 38, May 1997