IS IT REALLY SMALL FINDING ?

:
Small bowel obstruction (SBO)

Conventional abdominal radiography is the preferred initial 

radiologic examination . Results of this technique are 

diagnostic in 50%–60% of cases; equivocal in about 20%–


30%; and normal, nonspecific, or misleading in 10%–20% . If 

the findings on plain radiographs are those of an unequivocal

 SBO pattern and a high-grade partial or complete SBO is 

suspected, immediate surgical evaluation should be 

performed 


Findings at Plain Abdominal Radiography

The key radiographic signs that allow distinction between a 

high-grade SBO and a low-grade obstruction are

1. the presence of small bowel distention, with maximal 

dilated loops averaging 36 mm in diameter and exceeding 

50% of the caliber of the largest visible colon loop as well as

 a 2.5 times increase in the number of distended loops in the

 abdomen compared with the normal number.

2. the presence of more than two air-fluid levels,

3. air-fluid levels wider than 2.5 cm, and air-fluid levels 

differing more than 2 cm in height from one another within

 the same small bowel loop 

 High-grade SBO. Plain abdominal radiograph shows multiple

 air-fluid levels (arrows), some with a width of more than 2.5

 cm. In addition, there is a differential vertical height of more

 than 2 cm between corresponding air-fluid levels in the 

same bowel loop (circled area). There is also distention of 

the small bowel diameter to more than 2.5 cm and a small 

bowel–colon diameter ratio of greater than 0.5.

ADAPTED FROM RADIOGRAPHICS