Cl. Harlow et al., DIAGNOSIS OF BOWEL OBSTRUCTION ON PLAIN ABDOMINAL RADIOGRAPHS - SIGNIFICANCE OF AIR-FLUID LEVELS AT DIFFERENT HEIGHTS IN THE SAME LOOP OF BOWEL, American journal of roentgenology, 161(2), 1993, pp. 291-295
OBJECTIVE. Differential air-fluid levels are two distinct air-fluid in
terfaces on horizontal-beam abdominal radiographs that are at differen
t heights but within the same loop of bowel. Differential air-fluid le
vels have been considered by many to be strong evidence of mechanical
bowel obstruction, but others have found this sign unreliable for diff
erentiating mechanical from adynamic obstructions. Neither opinion is
supported by evidence from large series of patients. Accordingly, we d
etermined the efficacy of differential air-fluid levels for distinguis
hing mechanical from adynamic bowel obstruction. MATERIALS AND METHODS
. We identified patients who had a total of 62 episodes of proved mech
anical bowel obstruction and 38 episodes of adynamic obstruction throu
gh a computer search of medical records and radiographic files. On hor
izontal-beam abdominal radiographs of these patients, the presence and
height of intestinal differential air-fluid levels were determined by
the consensus of two experienced radiologists. These data were then s
tatistically analyzed to determine the usefulness of differential air-
fluid levels for distinguishing between mechanical and adynamic bowel
obstructions. RESULTS. Plain films showed differential air-fluid level
s in 32 (52%) of the 62 episodes of mechanical obstructions compared w
ith 11 (29%) of the 38 adynamic obstructions, giving a sensitivity for
mechanical obstruction of 0.52 and a specificity of 0.71. As the mini
mum significant height of differential air-fluid levels increased, spe
cificity increased and sensitivity decreased. The positive predictive
value also increased as differential air-fluid level heights increased
, reaching a level of 0.86 or greater at 20 mm. CONCLUSION. The presen
ce of differential air-fluid levels is an insensitive method of determ
ining if a bowel obstruction is mechanical, because only a small propo
rtion of mechanical obstructions have differential air-fluid levels. I
n our population of patients, however, a differential air-fluid level
of 20 mm or greater was moderately suggestive that a bowel obstruction
was mechanical in nature.