Imaging
Ileus
- Preliminary Diagnosis: Ileus
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of an ileus.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of an ileus.
- VI. What are the contraindications for the alternative imaging techniques?
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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