Emergency Radiology

, 1:138 | Cite as

Radiologic management of small bowel obstruction: A practical approach

  • Dean D. T. Maglinte
  • Hans Herlinger
  • William W. TurnerJr.
  • Frederick M. Kelvin
Review Article


The value of diagnostic imaging in the assessment of small bowel obstruction lies in its ability to answer questions to improve the clinical management of patients. These questions include: Is the small bowel obstructed? What are the level, cause, and severity of obstruction? Is strangulation likely to be present? Should treatment be operative or nonoperative? In this article, the different methods of contrast examination of the small bowel are reviewed, and recommendations to facilitate selection and performance of barium studies for small bowel obstruction are given. The indications for enteroclysis and computed tomography are discussed. A practical plain film-based approach to the diagnosis and management of small bowel obstruction is presented. Radiology assumes considerable importance and responsibility since it is able to supply relevant answers to many of the questions concerning small bowel obstruction.

Key Words

Intestines, stenosis or obstruction Intestines, enteroclysis Intestines, long tube decompression Intestines, CT Intestines, plain radiography 


  1. 1.
    Welch JP. General consideration and mortality in bowel obstruction. In: Welch JP, editor. Bowel obstruction: differential diagnosis and clinical management. Philadelphia: WB Saunders, 1990:59–95.Google Scholar
  2. 2.
    Savage PT. The management of acute intestinal obstruction: a critical review of 179 personal cases. Br J Surg 1960;47:643–54.PubMedCrossRefGoogle Scholar
  3. 3.
    Laws HL. Management of small bowel obstruction. Am Surg 1978;44:313.PubMedGoogle Scholar
  4. 4.
    Seror D, Feigin E, Szold A, et al. How conservatively can post-operative small bowel obstruction be treated? Am J Surg 1993;165:121–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Shrake PD, Rex DK, Lappas JC, Maglinte DDT. Radiographic evaluation of suspected small bowel obstruction. Am J Gastroenterol 1991;86:175–8.PubMedGoogle Scholar
  6. 6.
    Lo AM, Evans WF, Carey LC. Review of small bowel obstruction at Milwaukee County General Hospital. Am J Surg 1966;111:884–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Mucha P Jr. Small intestinal obstruction. Surg Clin North Am 1987;67:597–620.PubMedGoogle Scholar
  8. 8.
    Maglinte DDT, Lappas JC, Kelvin FM, et al. Small bowel radiography: how, when, and why? Radiology 1987;163:297–305.PubMedGoogle Scholar
  9. 9.
    Herlinger H, Maglinte DDT. Small bowel obstruction. In: Herlinger H, Maglinte DDT, editors. Clinical radiology of the small intestine. Philadelphia: WB Saunders, 1989:479–507.Google Scholar
  10. 10.
    Stalker LK. Barium as a factor in intestinal obstruction. Am J Surg 1946;72:756–9.CrossRefGoogle Scholar
  11. 11.
    Grossman RI, Miller WJ, Dann RW. Oral barium sulfate in large bowel obstruction. Radiology 1980;136:327–9.PubMedGoogle Scholar
  12. 12.
    Donato H, Mayo HW, Barr LH. The effect of peroral barium in partial obstruction of the small bowel. Surgery 1954;35:719–22.PubMedGoogle Scholar
  13. 13.
    Frimann-Dahl J. The administration of barium orally in acute obstruction: advantages and results. Acta Radiol 1954;42:285–95.PubMedCrossRefGoogle Scholar
  14. 14.
    Nelson SW, Christoforidis AJ. The use of barium sulfate suspensions in the study of suspected mechanical obstruction of the small intestine. AJR Am J Roentgenol 1968;104:505–21.Google Scholar
  15. 15.
    Harris PD, Neuhauser EBD, Gerth R. The osmotic effect of water-soluble contrast media on circulating plasma volume. AJR Am J Roentgenol 1964;91:694.Google Scholar
  16. 16.
    Wittenberg J. The diagnosis of colonic obstruction on plain abdominal radiographs: start with the cecum, leave the rectum to last. AJR Am J Roentgenol 1993;161:443–4.PubMedGoogle Scholar
  17. 17.
    Maglinte DDT, Herlinger H. Plain film radiography. In: Herlinger H, Maglinte DDT, editors. Clinical radiology of the small intestine. Philadelphia: WB Saunders, 1989:54–65.Google Scholar
  18. 18.
    Maglinte DDT, Miller RE. Intubation infusion method: reliability in diagnosis of mechanical partial small bowel obstruction. Mt Sinai J Med 1984;51:372–7.PubMedGoogle Scholar
  19. 19.
    Nolan DJ, Marks CJ. The barium infusion in small intestinal obstruction. Clin Radiol 1981;32:651–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Maglinte DDT, Burney BT, Miller RE. Lesions missed on small bowel follow-through: analysis and recommendations. Radiology 1982;144:737–9.PubMedGoogle Scholar
  21. 21.
    Bartram CI. The radiological demonstration of adhesions following surgery for inflammatory bowel disease. Br J Radiol 1980;53:650–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Maglinte DDT, Peterson LA, Vahey TN, et al. Enteroclysis in partial small bowel obstruction. Am J Surg 1984;147:325–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Sellink JL, Miller RE. Radiology of the small bowel. Hingham, MA: Martinus Nijhoff, Kluwer Boston, 1982:413–48.Google Scholar
  24. 24.
    Maglinte DDT, Miller RE, Lappas JC. Radiologic diagnosis of occult incisional hernias of the small intestine. AJR Am J Roentgenol 1984;142:931–2.PubMedGoogle Scholar
  25. 25.
    Ghahremani GG, Jimenez MA, Rosenfeld M, Rochester D. CT diagnosis of occult incisional hernias. AJR Am J Roentgenol 1987;148:139–42.PubMedGoogle Scholar
  26. 26.
    Maglinte DDT, Stevens LH, Hall RC, et al. Dual purpose tube for enteroclysis and nasogastric nasoenteric decompression. Radiology 1992;185:281–2.PubMedGoogle Scholar
  27. 27.
    Maglinte DDT, Kelvin FM, Micon LT, et al. Nasointestinal tube for decompression or enteroclysis: experience with 150 patients. Abdom Imaging 1994;19:108–12.PubMedCrossRefGoogle Scholar
  28. 28.
    Megibow AJ, Balthazar EJ, Cho KC, et al. Bowel obstruction: evaluation with CT. Radiology 1991;180:313–8.PubMedGoogle Scholar
  29. 29.
    Fukuya T, Hawes DR, Lu CC, Chang PJ, Barloon TJ. CT diagnosis of small bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol 1992;158:765–72.PubMedGoogle Scholar
  30. 30.
    Rubesin SE, Herlinger H. CT evaluation of bowel obstruction: a landmark article—implications for the future. Radiology 1991;180:307–8.PubMedGoogle Scholar
  31. 31.
    Stewart ET. Commentary: CT diagnosis of small-bowel obstruction. AJR Am J Roentgenol 1992;158:771–2.Google Scholar
  32. 32.
    Maglinte DDT, Gage S, Harmon B, et al. Obstruction of the small intestine: accuracy and role of CT in diagnosis. Radiology 1993;186:61–4.Google Scholar
  33. 33.
    Caroline DF, Herlinger H, Laufer I, et al. Small bowel enema in the diagnosis of adhesive obstructions. AJR Am J Roentgenol 1984;143:1133–9.Google Scholar
  34. 34.
    Day JJ, Freman AH, Coni NK, Dixon AK. Barium enema or computed tomography of the frail elderly patient? Clin Radiol 1993;48:48–51.PubMedCrossRefGoogle Scholar
  35. 35.
    Ellis H. Intestinal obstruction. New York: Appleton-Century-Crofts, 1982;39–50.Google Scholar
  36. 36.
    Welch J, Donaldson G. Management of severe obstruction of large bowel due to malignant disease. Am J Surg 1977;112:809–12.Google Scholar
  37. 37.
    Chapman AH, McNamara M, Porter G. The acute contrast enema in suspected large bowel obstruction: value and technique. Clin Radiol 1992;46:273–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Anuras S. Intestinal pseudoobstruction syndrome. Am Rev Med 1988;39:1–15.CrossRefGoogle Scholar
  39. 39.
    Richards W, Williams LF Jr. Pseudo-pseudo-obstruction—a clinically relevant concept. Am Surg 1989;55:26–31.PubMedGoogle Scholar
  40. 40.
    Maglinte DDT, Nolan D, Herlinger H. Preoperative diagnosis by enteroclysis of unsuspected closed loop obstruction in medically managed patients. J Clin Gastroenterol 1991;13:308–12.PubMedGoogle Scholar
  41. 41.
    Balthazar EJ, Birnbaum BA, Megibow AJ, et al. Closed loop and strangulating intestinal obstruction: CT signs. Radiology 1992;185:769–85.PubMedGoogle Scholar
  42. 42.
    Meiser G, Meisner K. Sonographic differential diagnosis of intestinal obstruction: results of a prospective study of 48 patients. Ultraschall Med 1985;6:39–45.PubMedCrossRefGoogle Scholar
  43. 43.
    Ko YT, Lim JH, Lee DH, et al. Small bowel obstruction: sonographic evaluation. Radiology 1993;188:649–53.PubMedGoogle Scholar
  44. 44.
    Fleischer AC, Parulekar S, Seibert JJ. Sonography of the small bowel. In: Herlinger H, Maglinte DDT, editors. Clinical radiology of the small intestine. Philadelphia: WB Saunders, 1989:153–9.Google Scholar
  45. 45.
    Chou C-K, Liu G-C, Chen L-T, Jaw T-S. The use of MRI in bowel obstruction. Abdom Imaging 1993;18:131–5.PubMedGoogle Scholar

Copyright information

© American Society of Emergency Radiology 1994

Authors and Affiliations

  • Dean D. T. Maglinte
    • 3
  • Hans Herlinger
    • 2
  • William W. TurnerJr.
    • 1
  • Frederick M. Kelvin
  1. 1.Surgery SectionMethodist Hospital of IndianaIndianapolis
  2. 2.Department of RadiologyHospital of the University of PennsylvaniaPhiladelphia
  3. 3.Department of RadiologyMethodist Hospital of IndianaIndianapolis

Personalised recommendations