IMAGING

NORMAL BOF, VOLVULUS, ILEUS, SMALL BOWEL OBSTRUCTION

Laras Prasast
NIM 1320111034
 Normal bowel gas pattern
• Normal bowel gas has
very variable appearance
• In this example the wavy
ruggae of the stomacht
wall can be seen
• A short segment of the
colon is prominent, but is
not frankly dilated
• Faecal material is visible
in the right hemi-colon

Royal College of Radiologist. http://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal 2

 Normal - with faeces
• This is a normal abdominal
X-Ray with faecal material
seen iin the large bowel.
There’s no evidene of bowel
obstructon or perforaton
• The psoas muscle edge is
clearly defined on the left,
but not on the right.
Although loss of this
contour is associated with
retroperitoneal pathology,
such as psoas abscesses, it
is also often absent on
normal X-rays. Therefore,
abdominal X-rays cannot be
used to confidently
diagnose retroperitoneal
problems

Royal College of Radiologist. http://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal 3

 Normal soft tissues
• Some abdominal X-rays
show soft tssue
structures better than
others. The liver, spleen
and kidneys are well-
defined in this image.
• X-rays are not routnely
used to assess these
organs. Ultrasound or CT
are much more
informatve.

Royal College of Radiologist. http://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal 4

 Caecal volvulus
• This patent has a
caecum which is not
retroperitoneal and is
therefore 'mobile' and
susceptble to twistng or
folding. The 'volvulus'
(twist/fold) has resulted
in dilataton of the
caecum.

Royal College of Radiologist. http://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/caecal_volvulus 5

 Caecal volvulus
• The caecum is grossly
dilated and is no longer
located in its anatomical
positon, the right iliac
fossa (RIF), which is
occupied by small bowel
in this example.

Royal College of Radiologist. http://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/caecal_volvulus 6

 Sigmoid volvulus - 'coffee
bean' sign
• Sigmoid volvulus is due
to a twist at the base of
the sigmoid mesentery
which is in a fixed
positon (asterisk) in the
left iliac fossa.
• This results in the
appearance of a giant
'coffee bean', the typical
sign of sigmoid volvulus.

Royal College of Radiologist. http://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/sigmoid_volvulus 7

 Sigmoid volvulus - 'coffee
bean' sign
• Here is another example
of the 'coffee bean' sign
of sigmoid volvulus.

Royal College of Radiologist. http://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/sigmoid_volvulus 8

 NORMAL LLD

http://www.pedxray.com/modules/images/images.php?id=2&image=315&langue=en&menu=26 9
 SMALL BOWEL OBSTRUCTION

Dilated loops of bowel with air-fluid levels at different levels is compatble

with a small bowel obstructon. "String of pearls" sign is present in the lower
abdomen.
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SMALL BOWEL OBSTRUCTION

Stepladder sign represents the appearance of air-fluid distended small bowel loops that
appear to be stacked on top of each other, typically observed on erect abdominal
radiographs in the setting of small bowel obstructon.
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