Key radiographic finding of bowel obstruction

Key radiographic finding of bowel obstruction

The hallmark of obstruction, whether mechanical or functional, is dilatation of bowel. The rule of “3s” defines abnormal dilation of the intestine:

  • • Small bowel 3 cm or larger
  • • Transverse colon 6 cm or larger
  • • Cecum 9 cm or larger

Differentiating bowel obstruction from paralytic ileus may be challenging, but several signs are suggestive: prominent abdominal distention, small bowel dilatation, and absence of large bowel dilatation all favor the diagnosis of small bowel obstruction. A “stepladder” configuration of dilated small bowel loops extending from the left upper to the right lower quadrants is highly suggestive. Although previously considered a reliable sign, air fluid levels in the same loop of small bowel at differing heights are not as dependable in diagnosing mechanical small bowel obstruction as initially thought.


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