Difference between revisions of "Barium swallow X-ray in bowel obstruction"
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==Evaluation== | ==Evaluation== | ||
;Distension: | ;Distension: | ||
| − | On abdominal X-rays, the small intestine is considered to be abnormally dilated when the diameter exceeds 3 cm.<ref name=medscape>{{cite web|url=http://emedicine.medscape.com/article/374962-overview|title=Small-Bowel Obstruction Imaging|website=[[Medscape]]|date=2016-09-22|author=Ali Nawaz Khan|accessdate=2017-02-07}}</ref><ref>{{cite web|url=http://www.radiologymasterclass.co.uk/tutorials/abdo/abdomen_x-ray_abnormalities/pathology_small_bowel_obstruction|title=Abdominal X-ray - Abnormal bowel gas pattern|website=radiologymasterclass.co.uk|accessdate=2017-02-07}}</ref> This number accounts for an expected geometric magnification in radiography, where the projection on the detector becomes larger than the actual organ. | + | On abdominal X-rays, the small intestine is considered to be abnormally dilated when the diameter exceeds 3 cm.<ref name=medscape>{{cite web|url=http://emedicine.medscape.com/article/374962-overview|title=Small-Bowel Obstruction Imaging|website=[[Medscape]]|date=2016-09-22|author=Ali Nawaz Khan|accessdate=2017-02-07}}</ref><ref>{{cite web|url=http://www.radiologymasterclass.co.uk/tutorials/abdo/abdomen_x-ray_abnormalities/pathology_small_bowel_obstruction|title=Abdominal X-ray - Abnormal bowel gas pattern|website=radiologymasterclass.co.uk|accessdate=2017-02-07}}</ref> This number accounts for an expected [[geometric magnification]] in radiography, where the projection on the detector becomes larger than the actual organ, with a factor that may be between 1.05 and 1.40.<ref>Estimated from radiographs of the chest and lumbar vertebral colon: {{cite web|title=Implementation of unsharpness and noise into the model of the imaging system: Applications to chest and lumbar spine screen-film radiography|url=https://www.diva-portal.org/smash/get/diva2:327957/FULLTEXT01.pdf|author=M Sandborg, D R Dance, and G Alm Carlsson|website=Faculty of Health Sciences, [[Linköping University]]}} Report 90. Jan. 1999. ISRN: LIU-RAD-R-090</ref> |
| − | + | {|class="wikitable" align="right" | |
| − | + | |+ Distension on CT<ref name="KuangZhao2016">{{cite journal|last1=Kuang|first1=Lian-qin|last2=Zhao|first2=Da-wei|last3=Cheng|first3=Cheng|last4=Wang|first4=Yi|title=Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings|journal=BioMed Research International|volume=2016|year=2016|pages=1–9|issn=2314-6133|doi=10.1155/2016/6569103}}</ref><ref name="JacobsRozenblit2007">{{cite journal|last1=Jacobs|first1=S.L.|last2=Rozenblit|first2=A.|last3=Ricci|first3=Z.|last4=Roberts|first4=J.|last5=Milikow|first5=D.|last6=Chernyak|first6=V.|last7=Wolf|first7=E.|title=Small bowel faeces sign in patients without small bowel obstruction|journal=Clinical Radiology|volume=62|issue=4|year=2007|pages=353–357|issn=00099260|doi=10.1016/j.crad.2006.11.007}}</ref> | |
| − | + | | Mild || 2.5–2.9 cm | |
| + | |- | ||
| + | | Moderate || 3-4 cm | ||
| + | |- | ||
| + | | Severe || >4 cm | ||
| + | |} | ||
| + | |||
| + | The exact geometric magnification of X-rays is not known, however, leaving mainly two options: | ||
| + | *Reporting a "roughly estimated" diameter by dividing the measured intestinal diameter in the image and dividing it by a rather arbitrary factor of 1.2. | ||
| + | *Reporting a qualitative diameter of the intestine, which may be on a mild-moderate-severe scale. However, the measured diameter still needs to be adjusted for geometric magnification in order to be compared to numbers in the table at right. | ||
==Report== | ==Report== | ||
Revision as of 17:32, 27 June 2018
Projectional radiography ("X-ray") with peroral intake of barium can determine whether a bowel obstruction is partial or incomplete, and may give clues to the cause.[1]
Contents
Planning
- Indication
After a CT in abdominal pain indicates bowel obstruction, but otherwise inconclusive.[1]
- Endpoint and chronology
Imaging is generally made until the contrast reaches the large colon (if small bowel obstruction is suspected). The first image may be taken at 2 hours after peroral contrast intake. If contrast hasn't reached the large intestine already, the frequency of further imaging depends on the progress, but the following repeat images are often made after 4-8 and then 6-10 hours.
Evaluation
- Distension
On abdominal X-rays, the small intestine is considered to be abnormally dilated when the diameter exceeds 3 cm.[2][3] This number accounts for an expected geometric magnification in radiography, where the projection on the detector becomes larger than the actual organ, with a factor that may be between 1.05 and 1.40.[4]
| Mild | 2.5–2.9 cm |
| Moderate | 3-4 cm |
| Severe | >4 cm |
The exact geometric magnification of X-rays is not known, however, leaving mainly two options:
- Reporting a "roughly estimated" diameter by dividing the measured intestinal diameter in the image and dividing it by a rather arbitrary factor of 1.2.
- Reporting a qualitative diameter of the intestine, which may be on a mild-moderate-severe scale. However, the measured diameter still needs to be adjusted for geometric magnification in order to be compared to numbers in the table at right.
Report
Should include:
- Time since intake of contrast.
- Any distension of the intestines.
- The most distal part reached by the contrast.
There also needs to be a decision when any repeat image is taken.
References
- ↑ 1.0 1.1 Thompson JS (2002). "Contrast radiography and intestinal obstruction. ". Ann Surg 236 (1): 7-8. PMID 12131079. PMC: 1422542. Archived from the original. .
- ↑ Ali Nawaz Khan (2016-09-22). Small-Bowel Obstruction Imaging. Medscape. Retrieved on 2017-02-07.
- ↑ . Abdominal X-ray - Abnormal bowel gas pattern. radiologymasterclass.co.uk. Retrieved on 2017-02-07.
- ↑ Estimated from radiographs of the chest and lumbar vertebral colon: M Sandborg, D R Dance, and G Alm Carlsson. Implementation of unsharpness and noise into the model of the imaging system: Applications to chest and lumbar spine screen-film radiography. Faculty of Health Sciences, Linköping University. Report 90. Jan. 1999. ISRN: LIU-RAD-R-090
- ↑ Kuang, Lian-qin; Zhao, Da-wei; Cheng, Cheng; Wang, Yi (2016). "Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings ". BioMed Research International 2016: 1–9. doi:. ISSN 2314-6133.
- ↑ Jacobs, S.L.; Rozenblit, A.; Ricci, Z.; Roberts, J.; Milikow, D.; Chernyak, V.; Wolf, E. (2007). "Small bowel faeces sign in patients without small bowel obstruction ". Clinical Radiology 62 (4): 353–357. doi:. ISSN 00099260.
