Documente Academic
Documente Profesional
Documente Cultură
© 2002
Recognizing
SBO, LBO and Ileus
Stomach
Always
Small Bowel
Two or three loops of non-distended
bowel
Normal diameter = 2.5 cm = 1 US
quarter
Large Bowel
In rectum or sigmoid – almost always
Gas in
stomach
Gas in a few
loops of
small bowel
Gas in
rectum or
sigmoid
Stomach
Always (except supine
film)
Small Bowel
Two or three levels
possible
Large Bowel
None normally
Always
air/fluid level
in stomach
A few
air/fluid
levels in
small bowel
Erect Abdomen
Large vs. Small Bowel
Large Bowel
Peripheral
Haustral markings don't
extend from wall to wall
Small Bowel
Central
Valvulae extend across
lumen
Maximum diameter of 2"
Complete Abdomen
Obstruction Series
Supine
Prone or lateral rectum
Erect or left decubitus
Chest - erect or supine
Complete Abdomen
Supine
Looking for
Scout film for gas
pattern
Calcifications
Soft tissue
masses
Substitute –
none
Complete Abdomen
Prone
Looking for
Gas in rectum/sigmoid
Gas in ascending and
descending colon
Substitute – lateral
rectum
Complete Abdomen
Erect
Looking for
Free air
Air-fluid levels
Substitute– left
lateral decubitus
Complete Abdomen
Erect Chest
Looking for
Free air
Pneumonia at bases
Pleural effusions
Substitute – supine
chest
Abnormal Gas Patterns
Functional Ileus
Localized (Sentinel
Loops)
Generalized adynamic
ileus
Mechanical Obstruction
SBO
LBO
Air in Rectum Air in Small Air in Large
or sigmoid Bowel Bowel
Multiple dilated
SBO No
loops
No
None-unless
Yes-
LBO No ileocecal valve
Dilated
incompetent
Localized Ileus
Key Features
Sentinel Loops
Sentinel Loops
Cholecystitis Pancreatitis
Ulcer
Appendicitis Diverticulitis
Ulcer
Ureteral calculus
Localized Ileus
Pitfalls
Mayresemble early
mechanical SBO
Clinical course
Get follow-up
Generalized Ileus
Key Features
Adhesions
Hernia*
Volvulus
Gallstoneileus*
Intussusception
LBO
Mechanical LBO
Causes
Tumor
Volvulus
Hernia
Diverticulitis
Intussusception
Mechanical LBO
Pitfalls
Multiple dilated
SBO No
loops
No
None-unless
Yes-
LBO No ileocecal valve
Dilated
incompetent
Special Cases
Air in
biliary
SBO tree
Localizedileus
Generalized ileus
Mechanical SBO
Mechanical LBO
Abdominal Images
What to Examine
Click to go forward
Click to go back
What abnormality is represented here?
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back Go ahead
What abnormality is represented here?
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back Go ahead
What abnormality is represented here?
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back Go ahead
What abnormality is represented here?
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back Go ahead
Correct
Go Back Go ahead
Correct
Go Back Go ahead
Correct
Go Back Go ahead
Wrong
Look Again
Go Back
Congratulations, You Graduate
You know
your
bowel gas