Diseases of the Abdomen and Pelvis 2018-2021 by Juerg Hodler Rahel A. Kubik-Huch & Gustav K. Schulthess

Author:Juerg Hodler, Rahel A. Kubik-Huch & Gustav K. Schulthess
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

SBO needs to be differentiated from LBO and from ileus and motility disorders involving the small and/or large bowel. Ileus of the small and/or large bowel is common after abdominal surgery and has multiple etiologies. In LBO, CT demonstrates distension of the colon to the point of obstruction, with collapse of the colon. The small bowel may demonstrate varying degrees of associated dilation. Colonic volvulus should be readily identified (Fig. 13.11), particularly on review of multi-planar reformations. A variety of CT signs have been reported, and volvulus may be complicated by ischemia and subsequent perforation. Marked dilation of most or all of the colon may be seen in toxic megacolon from a variety of etiologies, as well as in “pseudo-obstruction,” the latter of which also can lead to subsequent volvulus. A very common cause of abdominal pain in emergency department patients is constipation, which may be of varying degrees of severity, usually without an associated focal obstructing lesion. Other motility disorders, such as scleroderma and administration of anticholinergic or opioid medications, also may lead to the performance of CT, in patients presenting with acute abdominal pain.

Fig. 13.11(a, b) Cecal volvulus. Transverse CT image (a) and coronal CT reformation (b) demonstrate a markedly dilated cecum (C) located in the midline and left lower abdomen and upper pelvis. The arrow points to the area of colonic twisting. Note the dilated small bowel loops, due to the proximal colonic obstruction

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