While listening to the abdomen with a stethoscope your health care provider may hear high-pitched bowel sounds at the onset of mechanical obstruction. If the obstruction has persisted for too long or the bowel has been significantly damaged, bowel sounds decrease, eventually becoming silent.
Early paralytic ileus is marked by decreased or absent bowel sound.
Tests that show obstruction include:
* Abdominal CT scan
* Abdominal x-ray
* Barium enema
* Upper GI and small bowel series
Abdominal series
Supine and upright abdominal x-rays should be obtained and are usually adequate to diagnose obstruction. Although only laparotomy can definitively diagnose strangulation, careful serial clinical examination may provide early warning. Elevated WBCs and acidosis may indicate that strangulation has already occurred.
On plain x‑rays, a ladderlike series of distended small-bowel loops is typical of small-bowel obstruction but may also occur with obstruction of the right colon. Fluid levels in the bowel can be seen in upright views. Similar, although perhaps less dramatic, x‑ray findings and symptoms occur in ileus differentiation can be difficult. Distended loops and fluid levels may be absent with an obstruction of the upper jejunum or with closed-loop strangulating obstructions (as may occur with volvulus). Infarcted bowel may produce a mass effect on x‑ray. Gas in the bowel wall (pneumatosis intestinalis) indicates gangrene.
In large-bowel obstruction, abdominal x‑ray shows distention of the colon proximal to the obstruction. In cecal volvulus, there may be a large gas bubble in the mid-abdomen or left upper quadrant. With both cecal and sigmoidal volvulus, a contrast enema shows the site of obstruction by a typical “bird-beak” deformity at the site of the twist; the procedure may actually reduce a sigmoid volvulus. If contrast enema is not done, colonoscopy can be used to decompress a sigmoid volvulus but rarely works with a cecal volvulus.
X-Ray Picture Small Bowel Obstruction
Small Bowel Obstruction Upright View
Small Bowel Obstruction Supine View
Early paralytic ileus is marked by decreased or absent bowel sound.
Tests that show obstruction include:
* Abdominal CT scan
* Abdominal x-ray
* Barium enema
* Upper GI and small bowel series
Abdominal series
Supine and upright abdominal x-rays should be obtained and are usually adequate to diagnose obstruction. Although only laparotomy can definitively diagnose strangulation, careful serial clinical examination may provide early warning. Elevated WBCs and acidosis may indicate that strangulation has already occurred.
On plain x‑rays, a ladderlike series of distended small-bowel loops is typical of small-bowel obstruction but may also occur with obstruction of the right colon. Fluid levels in the bowel can be seen in upright views. Similar, although perhaps less dramatic, x‑ray findings and symptoms occur in ileus differentiation can be difficult. Distended loops and fluid levels may be absent with an obstruction of the upper jejunum or with closed-loop strangulating obstructions (as may occur with volvulus). Infarcted bowel may produce a mass effect on x‑ray. Gas in the bowel wall (pneumatosis intestinalis) indicates gangrene.
In large-bowel obstruction, abdominal x‑ray shows distention of the colon proximal to the obstruction. In cecal volvulus, there may be a large gas bubble in the mid-abdomen or left upper quadrant. With both cecal and sigmoidal volvulus, a contrast enema shows the site of obstruction by a typical “bird-beak” deformity at the site of the twist; the procedure may actually reduce a sigmoid volvulus. If contrast enema is not done, colonoscopy can be used to decompress a sigmoid volvulus but rarely works with a cecal volvulus.
X-Ray Picture Small Bowel Obstruction
Small Bowel Obstruction Upright View
Small Bowel Obstruction Supine View
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