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CT of Small-Bowel Obstruction

Another Perspective Using Multiplanar Reformations

¹ Both authors: Department of Radiology, Duke University Medical Center, P. O. Box 3808, Durham, NC 27710

View larger version (123K): [in a new window]   Fig. 1A. —67-year-old man with Crohn's disease who underwent terminal ileum resection and who presented with vomiting. Axial CT scan shows dilated loops of small bowel and collapsed colon (large arrow). Note narrowed segment of bowel (arrowhead) between two dilated loops of bowel, suggestive of proximal and distal obstruction point. Markers (small arrow) placed along transition from dilated to narrowed bowel define points of connection for curved coronal oblique reconstruction image shown in B.

View larger version (162K): [in a new window]   Fig. 1B. —67-year-old man with Crohn's disease who underwent terminal ileum resection and who presented with vomiting. Coronal oblique reformation along markers in A confirms fixed narrowing (arrowheads) with dilated bowel proximally and distally. Image also shows transition point more distally (arrow). At surgery, multiple adhesions were identified that caused two separate points of transition.

View larger version (160K): [in a new window]   Fig. 1C. —67-year-old man with Crohn's disease who underwent terminal ileum resection and who presented with vomiting. Sagittal oblique reformation shows narrowed segment (arrows) between two dilated loops of small bowel. No mass appears at transition point.

View larger version (146K): [in a new window]   Fig. 2A. —59-year-old woman who underwent abdominal hysterectomy and presented with abdominal pain and vomiting. Axial CT scan reveals dilated small bowel (arrow), collapsed small bowel (arrowhead), and ventral hernia (V). Line indicates plane of coronal oblique reconstruction in B.

View larger version (136K): [in a new window]   Fig. 2B. —59-year-old woman who underwent abdominal hysterectomy and presented with abdominal pain and vomiting. Coronal oblique reformation through defect in abdominal musculature shows mesenteric fat and small bowel contained in hernia sac (arrows). Plane of reformation is indicated by line in A. Note abdominal musculature (arrowheads).

View larger version (168K): [in a new window]   Fig. 2C. —59-year-old woman who underwent abdominal hysterectomy and presented with abdominal pain and vomiting. Sagittal oblique multiplanar reformation shows transition from dilated to collapsed bowel (arrows) at inferior aspect of fascial defect. Transition point was confirmed at surgery. Note reconstructed image is somewhat degraded by unsharpness and graininess. Noise could be reduced by decreasing slice thickness, decreasing pitch, or increasing percentage overlap on reconstructions.

View larger version (138K): [in a new window]   Fig. 3A. —84-year-old man who underwent partial gastrectomy for peptic ulcer disease and vomiting. Axial CT scan reveals small-bowel obstruction caused by incarcerated ileum (arrowheads) in retrocolic peritoneal defect. Internal hernia was confirmed at surgery and was likely caused by prior surgery.

View larger version (180K): [in a new window]   Fig. 3B. —84-year-old man who underwent partial gastrectomy for peptic ulcer disease and vomiting. Coronal oblique reformation reveals relationship of hernia sac (arrows) to retroperitoneal structures, including right kidney (k). Specific transition point could not be identified.

View larger version (127K): [in a new window]   Fig. 4A. —58-year-old woman with carcinoid and vomiting. Axial source image shows mild small-bowel dilatation and bowel wall thickening (arrow). Note enlarged lymph nodes and stranding in mesenteric fat. Oral contrast material has progressed to colon, suggesting low-grade obstruction.

View larger version (168K): [in a new window]   Fig. 4B. —58-year-old woman with carcinoid and vomiting. Coronal oblique reformation shows multiple loops of bowel with thick walls and increased attenuation in mesenteric fat (arrow). Findings are suggestive of serosal and mesenteric involvement by carcinoid.

View larger version (172K): [in a new window]   Fig. 4C. —58-year-old woman with carcinoid and vomiting. Sagittal oblique multiplanar reformation shows thickening of several loops of bowel (arrow).

View larger version (118K): [in a new window]   Fig. 5A. —74-year-old man who underwent right nephrectomy for renal cell carcinoma and radical cystoprostatectomy for transitional cell carcinoma. Patient received oral contrast material to help distinguish urinary diversion conduit from fluid-filled bowel. Axial CT scan shows low-attenuation pelvic mass (arrow) resulting from recurrent transitional cell carcinoma. Carcinoma caused small-bowel obstruction, and tumor was necrotic.

View larger version (165K): [in a new window]   Fig. 5B. —74-year-old man who underwent right nephrectomy for renal cell carcinoma and radical cystoprostatectomy for transitional cell carcinoma. Patient received oral contrast material to help distinguish urinary diversion conduit from fluid-filled bowel. Sagittal oblique reformation shows tumor encasing several loops of opacified small bowel (arrow) and extending to anterior abdominal wall (arrowhead).

View larger version (169K): [in a new window]   Fig. 5C. —74-year-old man who underwent right nephrectomy for renal cell carcinoma and radical cystoprostatectomy for transitional cell carcinoma. Patient received oral contrast material to help distinguish urinary diversion conduit from fluid-filled bowel. Coronal oblique reformation shows mass with several loops of opacified small bowel (arrow).

View larger version (169K): [in a new window]   Fig. 5D. —74-year-old man who underwent right nephrectomy for renal cell carcinoma and radical cystoprostatectomy for transitional cell carcinoma. Patient received oral contrast material to help distinguish urinary diversion conduit from fluid-filled bowel. Coronal oblique reformation shows hydroureteronephrosis (arrow) resulting from tumor involving distal left ureter.

View larger version (129K): [in a new window]   Fig. 6A. —47-year-old woman with Crohn's disease and vomiting. Axial CT scan shows dilated loops of small bowel and colon (arrow) and possible transition point in left lower quadrant.

View larger version (168K): [in a new window]   Fig. 6B. —47-year-old woman with Crohn's disease and vomiting. Coronal oblique reformation shows soft-tissue tracts (arrowheads) from small bowel to descending colon with surrounding inflammation and bowel wall thickening. At surgery, tract represented fistulous communication between inflamed loops of small bowel and descending colon.

View larger version (129K): [in a new window]   Fig. 7A. —28-year-old man with enterocolitis caused by Yersinia organisms. Axial CT scan shows dilated small bowel proximal to focal segment of bowel with thickened wall (arrowhead).

View larger version (165K): [in a new window]   Fig. 7B. —28-year-old man with enterocolitis caused by Yersinia organisms. Coronal oblique reformation shows relatively collapsed thick-walled bowel loop (arrowheads) in right abdomen.

View larger version (153K): [in a new window]   Fig. 7C. —28-year-old man with enterocolitis caused by Yersinia organisms. Sagittal oblique reformation reveals thick-walled segment of bowel (arrow).

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