Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities

Small bowel obstruction is a leading cause of acute surgical admissions for abdominal pain. There is an increasing tendency for initial conservative m anagement rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. This has resulted in a growing reliance o n radiological investigations to reassure the surgeon that medical therapy can be safely instituted. The onus therefore rests with radiologists to gui de their surgical colleagues by correctly interpreting the plain abdominal radiograph and suggesting appropriate further investigation if warranted. R ecently, computed tomography (CT) has been proposed as the test of choice t o define the level and cause of acute small bowel obstruction and to identi fy complications such as ischaemia and perforation which will prompt surgic al intervention. This review will discuss the utility of early CT in the di agnosis of acute small bowel obstruction and outline its impact on patient management.