Imaging
Large Bowel Obstruction
- Preliminary Diagnosis: Large Bowel Obstruction
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of large bowel obstruction.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of large bowel obstruction.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Large Bowel Obstruction
I. What imaging technique is first-line for this diagnosis
CT with IV and PO contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of large bowel obstruction.
Advantages
High sensitivity and specificity for large bowel obstruction
Identifies transition point of obstruction
Identifies degree of obstruction (low grade, high grade, or complete)
Can identifiy complications from obstruction (i.e., perforation, bowel ischemia)
May identify cause of large bowel obstruction (e.g., neoplasm, inflammatory disorder, volvulus), which will often affect clinical management
Disadvantages
Exposure to ionizing radiation
III. What are the contraindications for the first-line imaging technique?
If a complete or high grade obstruction is suspected, then PO contrast should not be given.
Due to radiation exposure, CT should be used conservatively in the pediatric population and is contraindicated in pregnancy.
IV. What alternative imaging techniques are available?
Plain radiograph
Barium enema
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of large bowel obstruction.
Plain radiograph
Advantages
May show large bowel dilatation, which can be diagnostic of large bowel obstruction
Can also demonstrate signs of complications from obstruction (e.g., pneumoperitoneum)
Disadvantages
Typically does not provide the cause, degree, or precise location of obstruction, which would often affect clinical management
Often not diagnostic
Barium enema
Advantages
Can clearly identify transition point in sigmoid originating large bowel obstructions.
Disadvantages
Does not provide any information on extracolonic abnormalities, which would identify cause of large bowel obstruction
Does not provide evidence of mural changes or complications from obstruction
Exposure to ionizing radiation
VI. What are the contraindications for the alternative imaging techniques?
Plain radiograph
No significant contraindications; may require consent for pregnant patients at some institutions
Barium enema
Contraindicated if perforation suspected
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