Diagnosis of Small Bowel Obstruction using Targeted Enterography During Nasointestinal Decompression

The aim of the study is to investigate the efficacy of using targeted enterography during intestinal decompression in the diagnosis of small bowel obstruction (SBO). Thirty-five patients with SBO and who had neither strangulation nor other contradictions received intestinal decompression, under the guidance of X-ray, using a 300-cm-long nasointestinal tube which reached the upper jejunum. Contrast radiography of intestines was performed when the tip of the decompression tube reached the obstruction by administering double-contrast medium, containing 20-100 ml 76 % gastrografin and 50-200 ml air, through the nasointestinal tube. Serial erect and supine plain abdominal radiographs were obtained. Intubation procedure was successful in all 35 patients. SBO was resolved in 20 patients, alleviated in 15 patients and 10 patients received surgery. Selective enterographies showed clear and high quality images. Imaging findings demonstrated no significant abnormality in six patients and adhesive SBO in 15. Furthermore, intestinal tumours were identified in four patients of which three were metastatic tumours and one was an original intestinal cancer; Crohn's disease was confirmed in three patients; radiation enteritis in three (one of them was misdiagnosed and was then confirmed as metastatic tumour during surgery); enteric intussusception was found in two patients; polyps in one patient and carcinoma of the ascending colon in one. Targeted enterography during nasointestinal decompression allows confirmation of pathology of SBO by direct identification of the location, the extent and aetiology of obstruction, thereby providing evidence for the choice of timing and strategy of surgery.