WIDI - CA0343-Small Bowel Obstruction & Pneumatosis

Small Bowel Obstruction & Pneumatosis

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History

57 year old female with abdominal pain, nausea, vomiting.

Exam

KUB/supine abdomen, upright abdomen, upright chest

Prior Study

None

Findings

Technique

The entire abdomen/pelvis is covered on the exam.

Lines, Tubes, Drains, and Foreign Bodies

There are post-surgical changes in the abdomen and pelvis.

Stomach and Bowel Gas

There is dilatation with gas and fluid of multiple loops of small bowel greater than 3 cm likely from partial or developing small bowel obstruction. There is some gas in the colon. There are multiple air-fluid levels involving the small bowel on the upright view of the abdomen.

Solid Organs and Intra-Abdominal Soft Tissues:

The solid organs and intra-abdominal soft tissues are normal. The right and left psoas muscles are mostly obscured by the bowel.

Extraluminal Air

There is no free air beneath the diaphragm on the upright view of the chest.

There is no extraluminal air or an abnormal focal collection of air in the abdomen or pelvis.

There is air in the wall of the small bowel from pneumatosis.

There is no portal venous or other intravascular gas.

Additional Abdominal and Pelvic Calcifications

None.

Bones and Extra-Abdominal Soft Tissues

The bones and extra-abdominal soft tissues are unremarkable.

On the upright view of the chest, there are no abnormalities. The lungs are clear. There is no free air.

Impression

There is dilatation of multiple loops of small bowel with air-fluid levels likely from distal obstruction. There is pneumatosis of multiple loops of small bowel which could indicate ischemia. There is no free air or portal venous gas. A CT scan is recommended for further evaluation.

Recommendations

Notify the clinical team immediately and verbally about findings of SBO and pneumatosis. Consider CT scan, surgical consult.

Acuity

Urgent: non-routine communication within 4 hours