Small bowel obstruction

Case contributed by Dr Henry Knipe

Presentation

Known small bowel obstruction. Previous bowel resection for diverticulitis. Study performed to see if resolution of bowel obstruction had occurred.

Patient Data

Age: 85 years
Gender: Female
Fluoroscopy

Small bowel follow-through

200 mL of Gastrografin was administered via an NGT after a preliminary film had been taken.

Results

Preliminary film. Gastrografin had been administered 24 hours previously.

Six hours after contrast administration the small bowel opacifies showing dilated loops measuring up to 5 cm. On the 11 hour film the contrast remains within the small bowel without progression into the colon and this is confirmed on the 16 hour film. Fecal material is seen within the colon. Pacemaker leads, left hip screw and costal cartilage calcification are noted. 

Conclusion

Features consistent with a persistent small bowel obstruction. 

Case Discussion

Small bowel obstructions (SBO) are a common surgical condition with significant morbidity and mortality. Small bowel follow-through contrast studies can be used to for diagnostic and/or therapeutic effects. Typical appearances of a SBO on a small bowel follow-through include dilatation of the small bowel without opacification of the large bowel. Perforation is a late complication of small bowel obstruction; in this case Gastrografin was the preferred contrast agent over barium because of the risk of barium peritonitis. 

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Case information

rID: 22673
Published: 15th Apr 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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