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Bowel Obstruction Revealed by Multidetector CT

¹ All authors: Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.

View larger version (140K): [in a new window]   Fig. 1A. —53-year-old woman with abdominal distention and prior appendectomy. Axial CT scan shows dilated small-bowel loops with possible transition (arrow) at level of distal ileum.

View larger version (130K): [in a new window]   Fig. 1B. —53-year-old woman with abdominal distention and prior appendectomy. Sagittal CT reformation clearly shows transition point (arrow). Adhesions were confirmed as cause of bowel obstruction at surgery.

View larger version (145K): [in a new window]   Fig. 2A. —79-year-old woman after partial colectomy complicated by ventral hernia. CT scan shows ventral hernia containing multiple dilated bowel loops (arrowheads).

View larger version (139K): [in a new window]   Fig. 2B. —79-year-old woman after partial colectomy complicated by ventral hernia. CT scan reveals site of obstruction as not within ventral hernia but distal to hernia (arrow). Numerous adhesions were found at surgery.

View larger version (138K): [in a new window]   Fig. 3A. —90-year-old woman with abdominal distention. CT scan shows several dilated fluid-filled small-bowel loops.

View larger version (146K): [in a new window]   Fig. 3B. —90-year-old woman with abdominal distention. Dilated loops can be followed on CT scan into left inguinal hernia (arrowheads), where a transition point is identified.

View larger version (155K): [in a new window]   Fig. 4A. —44-year-old woman who presented with abdominal pain and distention after hysterectomy. CT scan shows multiple dilated proximal small-bowel loops with air—fluid levels.

View larger version (149K): [in a new window]   Fig. 4B. —44-year-old woman who presented with abdominal pain and distention after hysterectomy. CT scan obtained more inferiorly than A reveals ventral hernia (arrow) as cause of obstruction. Fluid in sac raised possibility of strangulation; surgery revealed patchy mucosal ischemia but no transmural infarction.

View larger version (139K): [in a new window]   Fig. 5A. —64-year-old woman with ulcerative colitis and rectal cancer examined after total proctocolectomy and ileostomy. CT scan shows loops of dilated small bowel proximal to obstruction site.

View larger version (134K): [in a new window]   Fig. 5B. —64-year-old woman with ulcerative colitis and rectal cancer examined after total proctocolectomy and ileostomy. CT scan shows parastomal hernia (arrowheads) with transition point (arrow).

View larger version (115K): [in a new window]   Fig. 6. —59-year-old woman with no history of surgery who presented with increasing abdominal pain. CT scan shows dilated small-bowel loops with diffuse wall thickening and coning of mesentery (arrowheads) at site of transition. Possibility of ischemia was considered on basis of CT appearance; emergent surgery revealed internal hernia through which large amount of ileum had prolapsed and volvulated. Ischemic necrosis was confirmed, and approximately 1.2 m of small bowel was resected.

View larger version (131K): [in a new window]   Fig. 7A. —58-year-old woman with diabetes who presented with signs of bowel obstruction. Surgery confirmed mucosal ischemia. CT scan shows annular mass (arrowheads) in distal transverse colon, causing obstruction.

View larger version (119K): [in a new window]   Fig. 7B. —58-year-old woman with diabetes who presented with signs of bowel obstruction. Surgery confirmed mucosal ischemia. CT scan reveals significant distention of cecum with wall thickening (arrow) and trace of ascites.

View larger version (144K): [in a new window]   Fig. 8. —54-year-old man with diffuse abdominal distention. Contrast-enhanced CT scan with rectal contrast shows cecal mass infiltrating (arrow) and occluding ileocecal valve, resulting in bowel obstruction. Notice fecaloid appearance of small-bowel contents (CT small-bowel feces sign), likely caused by stasis and bacterial overgrowth.

View larger version (110K): [in a new window]   Fig. 9. —38-year-old man with history of testicular cancer. Contrast-enhanced CT scan shows extensive retroperitoneal lymphadenopathy, causing extrinsic compression (arrowheads), and small-bowel obstruction.

View larger version (140K): [in a new window]   Fig. 10A. —55-year-old woman with intussusception. Contrast-enhanced CT scan shows intussuscipiens (arrowheads) receiving intussuscepted mesenteric fat (arrow) and dilated proximal bowel loop (intussusceptum).

View larger version (138K): [in a new window]   Fig. 10B. —55-year-old woman with intussusception. Contrast-enhanced CT scan obtained more inferiorly than A reveals benign polyp (arrows) as lead point of intussusception.

View larger version (126K): [in a new window]   Fig. 11. —30-year-old man who presented with recurrent emesis after sigmoid colectomy for colon cancer. Contrast-enhanced CT scan shows dilated small-bowel loops with whirl sign (arrow), caused by twisting of mesenteric vessels suggestive of closed-loop obstruction. Surgery confirmed volvulus with ischemia.

View larger version (115K): [in a new window]   Fig. 12A. — 57-year-old woman with history of small-bowel resection who presented with signs of bowel obstruction. Axial CT scan shows several thick-walled fluid-filled small-bowel loops oriented in radial configuration (arrowheads) with site of prior surgery (metallic clip) at center.

View larger version (135K): [in a new window]   Fig. 12B. — 57-year-old woman with history of small-bowel resection who presented with signs of bowel obstruction. CT scan obtained more inferiorly than A shows diffuse bowel-wall thickening (arrows) and mesenteric congestion. Surgery confirmed small-bowel volvulus with ischemia caused by adhesions.

View larger version (160K): [in a new window]   Fig. 13A. —56-year-old woman with obstructing mass that precluded conventional colonoscopy. Enlarged sagittal CT colonographic reformation shows annular carcinoma (arrowheads) involving sigmoid colon.

View larger version (119K): [in a new window]   Fig. 13B. —56-year-old woman with obstructing mass that precluded conventional colonoscopy. Perspective endoluminal CT colonographic image shows significant luminal narrowing (arrow) caused by tumor.

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