Pain Imaging pp 323-346 | Cite as

Imaging of Bowel Obstruction and Bowel Perforation

  • Francesca Iacobellis
  • Ettore Laccetti
  • Federica Romano
  • Michele Altiero
  • Mariano Scaglione


Bowel obstruction and bowel perforation are common causes of acute abdominal pain. Clinical presentation may be insidious, and results of physical examination and laboratory values are often nonspecific and nondiagnostic. Thus, an imaging assessment is required. The target of the radiological evaluation is to define the etiology, to detect signs suggesting for immediate surgery, or to help the surgeon in deciding the correct timing of intervention. In this chapter, the diagnostic approach of these two conditions and the related main imaging findings are discussed.


Bowel obstruction Bowel occlusion Bowel perforation Pneumoperitoneum Acute abdomen 

Supplementary material

Video 17.1

CT abdomen and pelvis with contrast of a patient with acute complicated appendicitis (same patient of Fig. 17.2). The appendix is fluid distended, with an appendicolith in the lumen. There is a wall discontinuity with adjacent abscess extending in the pelvis. Due to reactive inflammatory phenomena there are several enlarged lymph nodes in the ileo-cecal region and thickening of the sigmoid wall. (MOV 17081 kb)

Video 17.2

CT abdomen and pelvis with contrast of a patient with closed-loop bowel obstruction 3 years after appendectomy (same patient of Fig. 17.5). A cluster of fluid distended small bowel loops in the right iliac fossa show thickened walls and decreased enhancement, consistent with closed-loop obstruction complicated with ischemic changes, due to postoperative adhesions. The dilated bowel loops proximal to the obstruction show fecaloid content due to dehydration of bowel content. (MOV 13595 kb)

Video 17.3

CT abdomen and pelvis with contrast of a patient with incarcerated laparocele (same patient of Fig. 17.6). There are ischemic changes of the herniated loops with a small amount of fluid in the herniated sac. Note also the presence of gas within the small venous mesenteric vessels and in intrahepatic portal system in keeping with pneumatosis. (MOV 18068 kb)

Video 17.4

CT abdomen and pelvis with contrast of a patient with bowel obstruction and perforation (same patient of Fig. 17.7). There is large pneumoperitoneum due to perforation related with an obstructing stenotizing mass of the splenic flexure. (MOV 20033 kb)

Video 17.5

CT abdomen and pelvis with contrast of a patient with bowel obstruction and previous history of right hemicolectomy (same patient of Fig. 17.8). There are signs of mechanical obstruction of the jejunum due to adhesions. A cluster of small bowel loops show dilated lumen with multiple valvulae conniventes. Some of the bowel loop are thinned with preserved enhancement whereas others are thickened with decreased enhancement due to ischemic bowel changes. (MOV 27921 kb)

Video 17.6

CT abdomen and pelvis with contrast of a patient with bowel obstruction and previous history of cholelithiasis (same patient of Fig. 17.9). The gallbladder shows thickened walls and air bubbles in its lumen. Signs of mechanical bowel obstruction are present, due to the presence of a gallstone in the small bowel lumen. (MOV 20226 kb)

Video 17.7

CT abdomen and pelvis with contrast of a patient with bowel obstruction due to sigmoid volvolus (same patient of Fig. 17.10). There are signs of mechanical bowel obstruction with an abnormal distension of the colonic lumen till the sigma, where a narrowing of the lumen and twisted mesenteric vessel are depicted. (MOV 15542 kb)

Video 17.8

CT abdomen and pelvis with contrast of a patient with bowel perforation (same patient of Fig. 17.11). The pneumoperitoneum is due to perforation of the ventral wall of the first duodenal loop. (MOV 14502 kb)

Video 17.9

CT abdomen and pelvis with contrast of a patient with bowel perforation (same patient of Fig. 17.12). The pneumoperitoneum is related with perforation of the pyloroduodenal junction. Signs of peritonitis are also present with thickening of bowel loops and free fluid in the abdomen. (MOV 16033 kb)

Video 17.10

CT abdomen and pelvis with contrast of a patient with bowel perforation 3 days after gastrectomy (same patient of Fig. 17.13). There is a large amount of extraluminal air with a “dirty mass” around the III portion of the duodenum. (MOV 13688 kb)

Video 17.11

CT abdomen and pelvis with contrast of a patient with gastric wall dehiscence after gastric bypass and esophageal endoprosthesis (same patient of Fig. 17.14). There is extravasation of oral contrast at the level of the anastomosis in the surrounding tissue, due to dehiscence. (MOV 19981 kb)

Video 17.12

CT abdomen and pelvis with contrast of a patient with bowel perforation (same patient of Fig. 17.15). There is free air in the lesser sac and above the right liver, due to a defect of the ventral wall of the duodenal bulb. The mesentery is congested with free fluid in the pelvis due to the inflammation. (MOV 11755 kb)

Video 17.13

CT abdomen and pelvis with contrast of a patient with diverticulitis (same patient of Fig. 17.16). There are multiple sigmoid diverticula with wall thickening, pericolic fat stranding and perivisceral free bubbles due to covered diverticular perforation. (MOV 11602 kb)

Video 17.14

CT abdomen and pelvis with contrast of a patient with complicated colonic neoplasm (same patient of Fig. 17.17). There is a large colonic mass at the splenic flexure with some peripheral low fluid hypodensities consistent with abscesses. These findings are keeping with a complicated colonic neoplasm. (MOV 13629 kb)

Video 17.15

CT abdomen and pelvis with contrast acquired in a patient with known diverticulitis (same patient of Fig. 17.18). Large amount of free air was detected in the retroperitoneal space due sigmoid diverticular perforation connected to an abscess collection. (MOV 17543 kb)

Video 17.16

CT abdomen and pelvis with contrast of a patient with perforated diverticulitis (same patient of Fig. 17.19). There are multiple sigmoid diverticula with wall submucosal thickening. Note the wall discontinuity with associated extraluminal dirty mass. A small amount of free air is also present. (MOV 11699 kb)

Video 17.17

CT abdomen and pelvis with contrast of a patient with perforated sigmoid mass (same patient of Fig. 17.20). There is an inhomogeneous thickening of the sigmoid colon with perivisceral inflammation and free air due to perforation. (MOV 14761 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Francesca Iacobellis
    • 1
    • 2
  • Ettore Laccetti
    • 1
  • Federica Romano
    • 1
  • Michele Altiero
    • 1
  • Mariano Scaglione
    • 1
    • 3
  1. 1.Department of Diagnostic Imaging“Pineta Grande” HospitalCastel Volturno (CE)Italy
  2. 2.Department of General and Emergency Radiology“A. Cardarelli” HospitalNaplesItaly
  3. 3.Department of RadiologySunderland Royal Hospital, NHSSunderlandUK

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