Intestinal Obstruction AXR

8/8/2019 Intestinal Obstruction AXR

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Case 1

A 36 year old male with vomiting- for 1/7

Ok. How to interpret this?

It looks normal isn't it? Of coz it's normal. We need to know which one

is normal. But if this normal, u still need to comment. What to look for

in a 'normal' x-ray anyway?


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Things to look for are

Technical Is the X-ray adequate?Is the gas in the correct place?Is there abnormal calcification or mass?Is the visualised bone and soft tissue normal?Any foreign bodies?

Case 2

8year old boy with abdominal pain


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Hoho..what do u think? Looks a bit shiny isn't it?

It's a metallic foreign body projected over the left iliac fossaNo dilated bowel loopsVery unlikely to cause intestinal obstructionCase 3

50 year old male with vomiting and NBO for 5/7

Look a bit bizarre rite? Take a proper look at the right side of the

inguinal region. Is that a bowel?

This is actually an inguinal hernia basically a clinical diagnosis. Why do


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we do an Xray then? To rull out intestinal obstruction.

Radiograph shows dilated small bowel in abdomenBowel in the left inguinal region extending into the scrotumCase 4

52 year old female with abdominal distension and vomiting for 2 days_

with a previous history of appendicectomy

Based from the history, adhesion would be more likely to cause

intestinal obstruction due to adhesions from the previous

appendicectomy.


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Note the multiple air fluid levels on the erect AXROn the supine radiograph dilated loops of air filled small bowelThere is one question so common to ask in viva - How do you

differentiate dilated small and large bowel?

Easy - Look a the bowel foldSmall bowel folds extend from one end of the bowel wall to the otherLarge bowel folds- Haustra extend about one third of the waySmall bowel is also more central in position in the abdomenCase 5

45 year old female with abdominal distension for 5 months


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This one abit difficult. Where is the bowel actually? This is a large

abdominal mass!

Bowel loops are displaced laterally and superiorly by a large soft tissue

mass which appears to arise from the pelvis. Note a dilated small

bowel loop in the right lumbar region.

Case 6

48 year old male post gastrectomy 1 day

This could be paralytic ileus. I forgot to tell u that apart from adhesion,


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paralytic ileus could also be the cause of Intestinal Obstruction.

However, an ileus can be diagnose based on abdominal examination

by absence of bowel sound.

Note dilated small and large bowel. Apart from paralytic ileus, sub

acute distal large bowel obstruction can give a identical appearance

Case 7

76 year old female with loss of weight for 3 months and now presents

with NBO for 3 days.

Note the dilated air filled large bowel, from the caecum to the splenic

flexure. This is a large bowel obstruction at the level of the splenic


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flexure.

This was due to carcinoma of the colon. A colonscopy would confirm

this diagnosis

Ba Enema (Limited)- would also confirm the diagnosis. A CT would

show the mass and is useful for staging

Case 8

30 year old female with non specific abdominal pain 1 year

Non specific abdominal pain.. If you see this in Primary Care, sure you

handle this as an irritable bowel syndrome.. HAHA..yup this one is a


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normal small bowel enema. Note the small bowel enema tube.

Normal small bowel folds which become less prominent in the ileum

Case 9

33 year old male with loss of weight 4 months and vomiting for 5/7

There is thickened small bowel folds and strictures

Diagnosis?

.

.


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.

.

It's a Lymphoma

Case 10

43 year old male with vomiting and lower abdominal pain- 1/7

This is a dilated loop of Large bowel. Inverted U shaped loop of large

bowel arising from the pelvis. Inverted U shaped loop of large bowel

arising from the pelvis. Suspect a volvulus (twist) of the sigmoid colon.

How to confirm?


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By doing a barium enema

Note the site of twist. This has been called the Birds Beak sign

Case 11

20 year old male with history of chronic constipation since childhood


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Diagnosis: Hirschprung Disease


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Grossly dilated large bowel

Filled with faeces

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Intestinal Obstruction AXR