Computed tomography of acute small bowel obstruction: pictorial essay

In many patients, the diagnosis of SBO can often be made by a combination of clinical history, physical examination and plain radiographs. However, in many cases, the diagnosis of SBO may be difficult. Abdominal radiographs are limited in their ability to diagnose SBO and, more particularly, to identify a specific underlying cause. Although barium studies, ultrasonography and magnetic resonance imaging may all play a role in the evaluation of SBO, CT should be the examination of choice for most patients when the diagnosis and underlying cause of SBO is unclear. It may help differentiate pseudo-obstruction from true obstruction, and a specific underlying cause can often be determined. Signs of closed-loop obstruction, strangulation, perforation or infarction may be detected and allow for more timely and appropriate surgical management. We advocate the use of CT in any patient with SBO where the cause or diagnosis is unclear. We have attempted to demonstrate a range of clinical cases in our practice where CT played an invaluable role in the evaluation of our patients.