In this episode we take you on a journey through the world of small bowel obstructions. Join us in discovering the 4 D's of Radiology of SBOs...

(For the full show notes and more information please visit learninginthedark.com)

Detect:

Symptoms - Colicky abdominal pain, distension, nausea and vomiting, constipation, inability to pass gas. 

Signs - High pitched, tinkling or absent bowel sounds

Often non specific

Describe:

Hallmark- Obstruction leading to dilation upstream and decompression downstream

Warning Signs-

1. Complete: nothing getting past 
2. Incomplete or Partial: some air and fluid post  
3. Closed Loop: Obstructed bowel at 2 points along the GI tract 
4. Strangulated obstruction 

 Differential:
Differential goes back to our common causes so break it down into intrinsic, extrinsic or intraluminal

Decision:
Conservative: NG decompression, bowel rest

Surgical: Resection indicated in high grade obstruction, bowel ischemia, failure to improve with conservative management 

Both clinical and radiological presentations can predict the need for surgical intervention 

• Clinical Predictors: 

1. Clinical signs of intestinal ischemia: abdominal pain worse despite conservative management, SIRS, Peritonitis, Metabolic Acidosis 
2. Failure of conservative management

• CT Indications for surgical management 
• Predictors of poor CT outcomes: 1.) Intraperitoneal free fluid 2.) Free intra-abdominal gas 3.) Duodenal distension 4.) High grade obstruction 5.) Signs of intestinal ischemia 6.) Closed Loop Obstruction 
• Surgical Correctable causes of SBO: 1.) Volvulus 2.) Incarcerated Hernia 3.) Closed Loop Obstruction 4.) Small Bowel Tumour 5.) gallstone ileus 6.) Foreign body ingestion
• Signs of small bowel obstruction with equivocal outcomes in regard to conservative vs. surgical intervention: Mesenteric congestion, presence of a transition point, small bowel feces sign

Produced By Mike Spouge