George W. Holmes Lecture. CT of small-bowel obstruction

The diagnosis of intestinal obstruction is established or suspected on clinical grounds, and it is usually confirmed with plain abdominal radiography. Because of significant limitations in the clinical and initial radiographic evaluations, antegrade or retrograde contrast-enhancement (barium, water-soluble media) studies are being additionally requested for about 20-30% of patients [1-6]. In the past few years, the steady advances in technology, technique, and interpretation have increased the value of CT in diagnosing and evaluating intestinal obstruction [7-10]. Although the precise role and contribution of CT are still being investigated and remain controversial, its significant clinical impact is already generally accepted. For patients thought to have mechanical intestinal obstruction who have confusing clinical and conventional radiographic findings, CT is currently used as a complementary imaging study, in direct competition with the more traditional gastrointestinal contrast-enhanced examinations generally used. The potential contribution of CT and its role, advantages, and limitations in the diagnosis and evaluation of intestinal obstruction are explored.