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Sbo, Lbo, Ileus
Sbo, Lbo, Ileus
2002
Recognizing
SBO, LBO and Ileus
Abdominal Images
What to Examine
Gas pattern-this lecture
Extraluminal air
Soft tissue masses
Calcifications-other
lectures
Small Bowel
Two or three loops of non-distended bowel
Normal diameter = 2.5 cm = 1 US quarter
Large Bowel
In rectum or sigmoid almost always
Gas in
stomach
Gas in a few
loops of
small bowel
Gas in
rectum or
sigmoid
Stomach
Always (except supine film)
Small Bowel
Two or three levels possible
Large Bowel
None normally
Always
air/fluid level
in stomach
A few
air/fluid
levels in
small bowel
Erect Abdomen
don't
extend from wall to wall
Small Bowel
Central
Valvulae
Complete Abdomen
Obstruction Series
Supine
Prone or lateral rectum
Erect or left decubitus
Chest - erect or supine
Complete Abdomen
Supine
Looking for
Scout film for gas
pattern
Calcifications
Soft tissue
masses
Substitute none
Complete Abdomen
Prone
Looking for
Gas in
rectum/sigmoid
Gas in ascending and
descending colon
Substitute lateral
rectum
Complete Abdomen
Erect
Looking for
Free air
Air-fluid levels
Substitute left
lateral decubitus
Complete Abdomen
Erect Chest
Looking for
Free air
Pneumonia at bases
Pleural effusions
Substitute supine
chest
Functional Ileus
Localized (Sentinel Loops)
Generalized adynamic ileus
Mechanical Obstruction
SBO
LBO
Localized Ileus
Key Features
Supine
Sentinel Loops
Prone
Sentinel Loops
Cholecystitis
Pancreatitis
Ulcer
Appendicitis
Diverticulitis
Ulcer
Ureteral calculus
Localized Ileus
Pitfalls
mechanical SBO
Clinical course
Get follow-up
Generalized Ileus
Key Features
Supine
Erect
Is It An Ileus?
hypoactive?
If no, then it isnt an ileus
Mechanical SBO
Key Features
SBO
Mechanical SBO
Causes
Adhesions
Hernia*
Volvulus
Gallstone ileus*
Intussusception
Mechanical SBO
Pitfalls
resemble localized
ileus -get F/O
Mechanical LBO
Key Features
obstruction
Little or no air in rectum/sigmoid
Little or no gas in small bowel, if
Ileocecal valve remains competent
Prone
Supine
LBO
Mechanical LBO
Causes
Tumor
Volvulus
Hernia
Diverticulitis
Intussusception
Mechanical LBO
Pitfalls
bowel
May look like SBO
Get BE or follow-up
Supine
Prone
Special Cases
Air in
biliary
tree
SBO
Gallstone
Gallstone Ileus
Post-op C-section
Adynamic Ileus
Sigmoid Volvulus
Mesenteric Occlusion
Localized ileus
Generalized ileus
Mechanical SBO
Mechanical LBO
Abdominal Images
What to Examine
Gas pattern-this lecture
Extraluminal air
Soft tissue masses
Calcifications-other
lectures
Important Points
Look for air in the rectum/sigmoid first
Identify the most dilated loops-are they large
Click to go forward
Click to go back
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back
Go ahead
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back
Go ahead
Focal Ileus
Generalized Ileus
SBO
LBO
Go Back
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Focal Ileus
Generalized Ileus
SBO
LBO
Go Back
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Correct
There are multiple aircontaining and dilated loops
of small bowel with little or
no gas in the colon. The
findings are those of a
mechanical small bowel
obstruction. The patient had
undergone prior surgery
and the cause of this
obstruction was adhesions
form the prior surgery.
Go Back
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Correct
There is a dilated colon
to the splenic flexure/
Little or no gas is seen
in the rectum or in the
small bowel. The
findings are those of a
mechanical large bowel
obstruction. The cause
was an annular
constricting carcinoma
at the splenic flexure.
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Correct
There are several aircontaining and slightly
dilated loops of small bowel
in the LLQ. These were
persistent. The findings are
those of a localized ileus
(sentinel loops) and their
location would suggest
diverticulitis. The patient had
appendicitis. The sentinel
loops do not always
correspond to the area of
inflammation.
Go Back
Go ahead
Correct
All of the bowel is dilated.
There is air in the rectum.
The patient was post-op
abdominal surgery and the
bowel sounds were absent.
This is a generalized
adynamic ileus as is seen
sometimes after abdominal
surgery.
Go Back
Go ahead
Wrong
Look Again
Go Back
You know
your
bowel gas