Ileus Obtruktif Letak Tinggi

Small Bowel Obstruction

Small Bowel Obstruction
Small Bowel Obstruction
Ileus Obstruktif Letak Rendah
Large Bowel Obstruction
Large Bowel Obstruction
Anteroposterior
supine abdominal
radiograph in a 67-
year-old man with
LBO shows dilated
ascending,
transverse, and
descending colon. A
transition point is
identified in the
region of splenic
flexure from an
obstructing colon
carcinoma (arrow).
 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.
Pneumoperitonium
 Free Intraperitoneal Air
Large collection of gas
Abdominal distension, no gastric air-fluid level
"Football sign" = large pneumoperitoneum outlining entire abdominal
cavity
"Double wall sign" = "Rigler sign" = air on both sides of bowel as
intraluminal gas and free air outside (usually requires >1,000 mL of free
intraperitoneal gas + intraperitoneal fluid)
"Telltale triangle sign" = triangular air pocket between 3 loops of bowel
Depiction of diaphragmatic muscle slips = two or three 6-13 cm long and
8-10 mm wide arcuate soft-tissue bands directed vertically inferiorly +
arching parallel to diaphragmatic dome superiorly outline of ligaments of
anterior inferior abdominal wall:
"Inverted V sign" = outline of both lateral umbilical ligaments (containing
inferior epigastric vessels)
Outline of medial umbilical ligaments (obliterated umbilical arteries)
"Urachus sign" = outline of middle umbilical ligament
Double wall sign/ Rigler Sign
Riglers Sign
 RUQ gas (best place to look for small collections)Single large
area of hyperlucency over the liver

Oblique linear area of hyperlucency outlining the posteroinferior margin of liver

Doge's cap sign = triangular collection of gas in Morrison pouch (posterior
hepatorenal space)
Outline of falciform ligament = long vertical line to the right of midline extending
from ligamentum teres notch to umbilicus; most common structure outlined
Lligamentum teres notch = inverted V-shaped area of hyperlucency along
undersurface of liver
Ligamentum teres sign = air outlining fissure of ligamentum teres hepatis (=
posterior free edge of falciform ligament) seen as vertically oriented sharply
defined slitlike / oval area of hyperlucency between 10th and 12th rib within 2.5-
4.0 cm of right vertebral border 2-7 mm wide and 6-20 mm long
"Saddlebag / mustache / cupola sign" = gas trapped below central tendon of
diaphragm
Parahepatic air = gas bubble lateral to right edge of liver
Saddle Bag sign
Initial abdominal
film, in left lateral
decubitus position
demonstrating large
amount of free air
(black arrows),
dilated loops of
bowel (double white
arrows) and inferior
and medial
displacement of the
liver (saddle bag
sign [triple clear
arrows]).
Ileus Paralitik
Anterior subhepatic space free air
Doges cap sign/morrison pouch
Air anterior to ventral surface liver
Riglers sign
Decubitus abdomen sign
Falciform Ligament Sign
The football sign
Continous diaphragm sign
Double bubble sign
The cupola sign
Lesser sac Gas
The triangle sign
Abcess Gas
Pneumoretroperitonium
Uracus Sign
The inverted V sign
Leaping Dolphins sign
Ligamentum teres sign