Original article
ACR Appropriateness Criteria® on Suspected Small-Bowel Obstruction

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With no one generally accepted approach to evaluate patients with suspected small-bowel obstruction (SBO), standard CT has emerged as the preeminent imaging modality and should be considered in the initial evaluation of patients with suspected high-grade SBO. Playing less significant roles in the diagnosis of acute SBO are barium enemas and the small-bowel examination.

Section snippets

Summary of literature review

There is no single generally accepted approach to evaluate patients with suspected small-bowel obstruction (SBO). This in part reflects not only the differing perspectives of investigators who have written on the topic (surgeons and radiologists) but also the increasing application of sophisticated imaging studies. The diagnostic approach also depends on the clinical presentation (ie, acute high grade vs low grade or intermittent) [1].

Plain-film radiography has been the traditional starting

Conclusions

Standard CT has emerged as the preeminent imaging modality for the evaluation of SBO and should be considered in the initial evaluation of patients with suspected high-grade SBO. The barium enema and small-bowel examination play less significant roles and should not be used as primary modalities in the diagnosis of acute SBO.

If intermittent or low-grade SBO is a chief diagnostic concern, standard or computed tomographic enteroclysis is appropriate [1, 3, 15, 16]. Computed tomographic

Acknowledgments

We wish to thank the following members of the Gastrointestinal Imaging Panel on Appropriateness Criteria®: Robert L. Bree, MD, MHSA; W. Dennis Foley, MD; Spencer B. Gay, MD; Seth N. Glick, MD; Jay P. Heiken, MD; Marc S. Levine, MD; Max Paul Rosen, MD, MPH; William P. Shuman, MD; and Frederick L. Greene, MD (American College of Surgeons).

Disclaimer: The ACR Committee on Appropriateness Criteria® and its expert panels have developed criteria for determining appropriate imaging examinations for

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