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Bowel Obstruction and Ileus: Large Bowel Obstruction & Ogilvie Syndrome – Radiology | Lecturio


[Music] so let’s move on to large bowel obstruction this is usually caused by a mechanical obstruction of the large bowel and the cecum is usually the part of the bowel that dilates the most the small bowel is often not dilated unless the obstruction is so severe that it makes the ileocecal valve incompetent in a large bowel obstruction you don’t want to administer oral barium because it couldn’t become impacted within the bowel as water is absorbed from it so you want to start off by doing a plain film and if you suspect a large bowel obstruction then don’t administer the oral contrast so let’s move onto volvulus a volvulus is essentially a closed loop obstruction involving the large bowel it’s most commonly seen in the sigmoid area and then it’s followed by the cecal area sigmoid volvulus tends to produce a characteristic coffee bean shape appearance on radiographs with a sequal volvulus you actually see a very dilated cecum that often rotates to the left upper abdomen on this film you can see what appears to be a very dilated cecum it remains within the pelvis in this patient the small bowel will become dilated with the volvulus and as with a small bowel volvulus there’s a very high risk of strangulation so let’s take a look at this film you can see the green line showing you a very dilated loop of large bowel so what does this represent this is actually an example of a sigmoid volvulus and you can see this is the characteristic coffee bean shape that you would expect this is a surgical specimen demonstrating the same thing as sigmoid volvulus so a colonoscopy is used to reduce the volvulus most often occasionally you can use a contrast enema however you have to be careful because when you reduce the value list there is a high risk of perforation so what are other secondary science of volvulus you can see the world scene which is swirling of the mesentery and that can be seen with both large volvulus and small bowel closed-loop obstruction you can also see what’s called the beak sign we tapering the colon to the point of obstruction so let’s take a look at these images this is an axial CT image in a patient that has a closed loop obstruction and here you can see what’s called the beak sign so you can see tapering of the colon producing the appearance of a beak and then on the coronal image keep your eye on this area right here as I scroll through you can see what looks like a swirling of this mesentery and this is another secondary sign of volvulus so Olga V syndrome is actually massive dilatation of the colon without mechanical obstruction so as you recall normal large bowel obstruction is often due to a mechanical obstruction this is one of the causes of a non mechanical obstruction that can cause dilatation of the colon usually this is due to anticholinergics which result in loss of peristalsis trauma especially retroperitoneal serious infection and cardiac disease so let’s go back to this case that we saw at the very beginning this is our 25 year old female that presents with the right lower abdominal pain what do you see on this film so we see multiple loops of large bowel that contain air and that’s normal but how about right here what does that represent so this is a prominent loop of airfield small-bowel that’s seen in the left upper abdomen and this is consistent with the focal Ilyas as you can see here it has that stacked coin appearance that we talked about so what’s the next step how do you figure out what’s going on why does this patient have a focal Ilyas so you want to obtain a CT of the abdomen and pelvis with contrast to take a look for any kind of causes remember there are multiple different causes of a small bowel focal Ilyas so let’s take a look at this axial contrast-enhanced CT scan and if you look right here you actually have a very thick walled appendix with periya pandi seal fat stranding let’s take a closer look so this portion right here is all appendix normally appendix should have a little bit of air or a little bit of contrast within it but you actually don’t see the lumen at all because the wall is so thick and if you look around it let’s take a look at normal mesentery so this area right here is normal mesentery surrounding the appendix the mesentery has a more grayish appearance and this is because of surrounding inflammation so this patient has an acute appendicitis that caused her focal ileus so we’ve gone over multiple different causes of large and small bowel obstruction again this is a very common finding that you want to look out for when you see a patient coming in with abdominal pain [Music]

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