Presentation
24 hours of abdominal pain and obstipation, background of multiple abdominal surgeries.
Patient Data
Preliminary film prior to...
Preliminary film prior to oral contrast administration.
Multiple dilated loops of small bowel measuring up to 4 cm suspicious for small bowel obstruction. Nasogastric tube projecting over the stomach. Surgical clips in right upper quadrant and material in the pelvis indicate prior surgeries.
24 hours Post oral contrast
Contrast is seen throughout the large bowel 24 hours post oral contrast. NGT still in situ.
3 days post oral contrast...
3 days post oral contrast ongoing vomiting bowels still not open.
Multiple dilated loops of small bowel measuring up to 5 cm. Mildly dilated loop of colon measuring up to 6.5 cm. Compared to prior imaging the transverse colon is progressively dilated and the contrast is unchanged in position, reaching up to the sigmoid colon.
Case Discussion
The administration of oral contrast is a common management strategy for patients presenting with small bowel obstruction (SBO). The presence of oral contrast in the large bowel at 24 hours post administration predicts spontaneous resolution. However, the case presented demonstrates an exception to the rule. The patient had an abdominal CT proving a SBO with a single transition point (not shown). At 24 hours post (Gastrografin) oral contrast, contrast is seen throughout the large bowel. However the patient still had ongoing clinical signs and symptoms of SBO and a repeat radiograph at 72 hours shows ongoing dilation of small bowel. The patient went on to have laparoscopic adhesiolysis of omental adhesions. Her SBO subsequently resolved.
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