CT evaluation of small bowel obstruction

Although small bowel obstruction is a common occurrence, it is essential th at this clinical condition be treated properly, that the site, level, and c ause of obstruction be determined accurately, and that a tentative prognosi s be formulated prior to surgery. The diagnosis of small bowel obstruction is based on a comprehensive approach that includes clinical background, pat ient history, and results of physical examination and laboratory tests. A v ariety of radiologic procedures are available to aid in the diagnosis of sm all bowel obstruction. Recent studies have demonstrated the superiority of CT in revealing the site, level, and cause of obstruction and in demonstrat ing threatening signs of bowel inviability. CT has proved useful in charact erizing small bowel obstruction from extrinsic causes (adhesions, closed lo op, strangulation, hernia, extrinsic masses), intrinsic causes (adeno carci noma, Crohn disease, tuberculosis, radiation enteropathy, intramural hemorr hage, intussusception), intraluminal causes (eg, bezoars), or intestinal ma lrotation. Conventional radiography was the modality of choice for many yea rs and should remain the initial imaging method in patients with suspected small bowel obstruction. However, the unique capabilities of CT in this set ting make this modality an important additional diagnostic tool when specif ic disease management issues must be addressed.