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Small-Bowel Obstruction: CT Features with Plain Film and US correlations

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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.
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