Imaging

Ileus

Preliminary Diagnosis: Ileus

I. What imaging technique is first-line for this diagnosis?

  • Plain abdominal radiography

II. Describe the advantages and disadvantages of this technique for diagnosis of an ileus.

Advantages

  • Quick, efficient, and cost-effective modality to evaluate for an ileus

  • Uses less ionizing radiation than CT imaging and fluoroscopy

Disadvantages

  • May not be able to localize a primary abdominal or pelvic inflammatory or infectious process that causes a secondary ileus

III. What are the contraindications for the first-line imaging technique?

  • No significant contraindications to plain radiography exist.

IV. What alternative imaging techniques are available?

  • Nonenhanced CT

  • Fluoroscopy

  • Upper GI examination

  • Contrast enema

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of an ileus.

CT without contrast

Advantages

  • May help evaluate for a partial obstruction and localize a transition point where the differential includes a dynamic ileus versus partial bowel obstruction

  • May localize a primary abdominal or pelvic inflammatory process that may elicit a secondary dynamic ileus so that the primary process may be treated

Disadvantages

  • Exposes the patient to much more ionizing radiation when compared to plain radiography

  • Patients susceptible to more motion artifact as CT imaging scan times are longer than plain radiography

Fluoroscopy

Advantages

  • Able to evaluate for a mechanical obstructing upper gastrointestinal lesion as contrast propagates distally

Disadvantages

  • Exposes the patient to more ionizing radiation than plain radiography

Upper GI examination

Advantages

  • Ingestion of oral contrast is patient dependent and may be time-consuming in noncooperative patients.

Disadvantages

  • A normal upper GI examination may not rule out a distal bowel obstruction.

Contrast enema

Advantages

  • Contrast enema may be therapeutic and stimulate bowel peristalsis.

  • Normal contrast enema may rule out colonic mechanical obstruction.

Disadvantages

  • Normal contrast enema may not rule out upper GI obstruction.

  • Contrast enema examinations are painful and irritating as the contrast causes colonic distention.

VI. What are the contraindications for the alternative imaging techniques?

CT without contrast

  • Contraindicated in pregnant patients, especially within the first two trimesters

Fluoroscopy

  • Contraindicated in pregnant patients, especially within the first two trimesters

Upper GI examination

  • Upper GI and contrast enema examination are contraindicated in patients with esophageal, stomach, or bowel perforation and associated free air

Contrast enema

  • Contraindicated in patients with esophageal, stomach, or bowel perforation

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