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Imaging of acute small bowel obstruction

Radiology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK

• Small bowel obstruction is a common clinical condition for which imaging is used earlier and increasingly frequently in the diagnostic workup.
  
• High-grade obstruction is sensitively and specifically identified on CT. CT may establish a cause, from adhesional obstruction, intrinsic lesions such as tumours or intussusception, luminal obstruction or extrinsic lesions like a hernia.
  
• CT can additionally allow assessment of the complications of obstruction, both strangulation and closed-loop obstruction.
  
• There remains an important role of conventional radiography. Plain abdominal films are cheap and readily available. They are able to triage high- from low-grade obstruction and can be used to follow the progress of conservatively managed patients.
  

Small bowel obstruction (SBO) is a common condition in which rapid establishment of the diagnosis, cause and severity is essential for safe and effective management. Whilst the clinical cornerstones of history and examination remain, imaging is increasingly used at an earlier stage of the diagnostic workup. CT is the most sensitive and specific test, and allows diagnosis of the causation and an assessment of potential complications. However, there remains a role for both plain and contrast radiography. We shall review the role of imaging in the diagnosis of SBO and the imaging findings of the range of causes.