Which imaging study is recommended for suspected small bowel obstruction?

Which imaging study is recommended for suspected small bowel obstruction?

• A. Abdominal radiograph
• B. Ultrasound
• C. MRI
• D. CT with IV and PO contrast

Answer: (D)

When small bowel obstruction is suspected, a CT scan of the abdomen and pelvis with both IV and oral contrast is the most informative single test. It quickly shows the exact level of obstruction and the transition point, helps identify the cause (such as adhesions, a hernia, or a mass), and assesses bowel viability by evaluating wall enhancement, edema, and surrounding mesentery. It also detects complications like strangulation, perforation, free fluid, or pneumatosis, which are critical for deciding whether nonoperative management is appropriate or urgent surgery is needed. Other imaging options have limitations: plain abdominal radiographs can reveal dilated loops and air-fluid levels but miss many cases and don’t clearly define cause or viability; ultrasound can show dilated loops but is hampered by gas, obesity, and operator dependence; MRI offers excellent detail but is slower and less practical in acute settings.

When small bowel obstruction is suspected, a CT scan of the abdomen and pelvis with both IV and oral contrast is the most informative single test. It quickly shows the exact level of obstruction and the transition point, helps identify the cause (such as adhesions, a hernia, or a mass), and assesses bowel viability by evaluating wall enhancement, edema, and surrounding mesentery. It also detects complications like strangulation, perforation, free fluid, or pneumatosis, which are critical for deciding whether nonoperative management is appropriate or urgent surgery is needed.

Other imaging options have limitations: plain abdominal radiographs can reveal dilated loops and air-fluid levels but miss many cases and don’t clearly define cause or viability; ultrasound can show dilated loops but is hampered by gas, obesity, and operator dependence; MRI offers excellent detail but is slower and less practical in acute settings.