Original articleACR Appropriateness Criteria® on Suspected Small-Bowel Obstruction
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
References (43)
Computed tomography compared with small bowel enema in clinically equivocal intestinal obstruction
Clin Radiol
(1998)- et al.
Value of radiopaque markers in identifying partial small bowel obstruction
Gastroenterology
(1996) - et al.
Clinical application of ultrasonography in the diagnosis of intussusception
J Pediatr
(1992) - et al.
Preoperative evaluation by magnetic resonance imaging in patients with bowel obstruction
Am J Surgery
(2002) - et al.
Comparison of computed tomography-enteroclysis and traditional computed tomography in the setting of suspected partial small-bowel obstruction
Emerg Radiol
(1998) Degree of bowel distention on plain radiographs—a surgical-radiological study of new criteria in mechanical intestinal obstruction
Jpn J Surg
(1978)- et al.
Radiographic evaluation of suspected small bowel obstruction
Am J Roentgenol
(1991) - et al.
CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause
Am J Roentgenol
(1994) - et al.
CT diagnosis of small-bowel obstruction: efficacy in 60 patients
Am J Roentgenol
(1992) - et al.
Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction
Am J Roentgenol
(1996)