Image Based Question On Intestinal Obstruction

Differentiate Small Bowel Obstruction From Large Bowel Obstruction?

Small bowel is placed centrally and is narrow is caliber · Large bowel is placed peripherally and is wider in caliber and has haustration.

Differentiate Partial Obstruction From Complete Obstruction?

Look for gas in rectum o Gas present in rectum →Partial obstruction .Gas absent in rectum →Complete obstruction.

Small Bowel Obstruction

In the below image, supine view shows dilated bowel loops placed centrally and upright view showing multiple air fluid level in STEP-LADDER PATTERN suggestive small bowel obstruction. Diameter of SB in obstruction is > 3-5 cm.

Large Bowel Obstruction

Given image is of large bowel obstruction, supine view shows dilated bowel loops placed peripherally wider in caliber and there is presence of haustration, in upright view multiple air fluid levels seen suggesting large bowel obstruction o Diameter of LB in obstruction is > 5cm.

Diagnosis: Intussusception

USG shows TARGET lesion on transverse scan · On Longitudinal scan you can see Pseudo Kidney sign · Both suggesting Intussusception.

Diagnosis: Midgut Volvulus 

Given image shows Whirlpool sign · M/C site of volvulus – Sigmoid Volvulus · Sigmoid volvulus can be both clockwise and an-clockwise but more commonly an-clockwise.

Signs of Sigmoid Volvulus on X-ray

Coffee bean sign · Omega Sign · Bent inner tube.

Sign on Barium enema

Bird beak · Ace of spade sign · Bird of prey sign.

Bird Beak Sign On Barium Swallow Suggest Achalasia Cardia

Kidney Bean sign seen on Cecal Volvulus · Comma shaped caecum.

Diagnosis: TB of Small Intestine 

 Transverse ulcer of small intestine sugging TB · Ulcer →Fibrosis →Stricture formation · In Typhoid →Longitudinal ulcer.

Radiological Signs of TB

In barium meal follow through you can notice - Pulled up cecum, Obtuse IC angle, Goose neck deformity · Sterlein sign → Narrowed terminal ileum due to hyperirritability because of the presence of ulcers · String sign of Kantor → Permanent narrowing of terminal ileum due to formation of stricture.

Sterling sign and string sign of Kantor are also seen in crohn's disease.

Also read: High-Yield GIT, Hepatobiliary and Pancreatic Surgery Questions

Hope you found this blog helpful for your GIT, Hepatobiliary and Pancreatic Surgery preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.