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Small–bowel obstruction (SBO) is responsible for about 15% of surgical
operations for an acute abdomen. In Italy, the most frequent causes of SBO
are adhesions (about 60%), hernias (about 20%) and neoplasms (about
15%).Comparison with other countries is interesting. In the USA, the most
frequent cause of SBO is adhesional syndrome (50–75%), followed by
stenosing Crohn’s enteritis and neoplasms; it is interesting to note that hernias
are not present due to extensive preventive measures for external hernias.
On the contrary, in developing countries, hernias still account for
about 78% of SBO as a consequence of the lack of preventive measures.
Furthermore, due to the limited number of performed abdominal surgeries,
adhesional syndrome is only responsible for 10% of the cases.
SBO is characterised by interruption of lumen continuity, with acute intestinal
changes in canalisation. The obstructive site causes dilatation of
intestinal loops proximal and progressive collapse of the loops distal. Intestinal
stasis is always mixed: gaseous and liquid. SBO has an intrinsic dynamism:
in other words, it is capable of evolutionary development.
New imaging methods have basically revolutionised the role of conventional
radiology in the evaluation of the acute abdomen.Nevertheless, abdominal
plain film still a role in the study of acute intestinal behaviours.
In suspected SBO, we always perform ultrasonography (US) as an integrative
modality to abdominal plain film. US confirms and supports the diagnosis,
offers additional, important findings and enhances overall diagnostic
confidence.To date, contrast–enhanced multidetector computed tomography
(MDCT) is the gold standard in the study of SBO. In the diagnostic
work–up of SBO,MDCT can be performed both as the first imaging
modality and as an integrative modality to US–plain film study. |