“Small-bowel obstruction (SBO) is responsible for up to 16% of hospital admissions for abdominal pain with mortality ranging between 2% and 8% overall, and as high as 25%
when associated with bowel ischemia. Radiologic imaging plays the key role in the diagnosis and management of SBO because neither patient presentation, the clinical examination, nor laboratory testing are sufficiently sensitive or specific enough to diagnose or guide management. Imaging not only diagnoses the presence of SBO but also can aid in the differentiation of high-grade from low-grade obstruction. This differentiation helps to guide referring physicians between surgical treatment for high-grade or complicated SBO versus conservative management with enteric tube decompression.”

SUMMARY OF RECOMMENDATIONS

“Variant 1: CT abdomen and pelvis with IV contrast is usually appropriate for the initial imaging of a suspected SBO with an acute presentation. The panel did not agree on recommending radiographs of the abdomen and pelvis in patients with an acute presentation of suspected SBO. There is insufficient medical literature to conclude whether
or not these patients would benefit from this procedure. This procedure is controversial but may be appropriate as an initial imaging examination to direct further workup (which would usually include a CT of the abdomen and pelvis with IV contrast).

Variant 2: CT abdomen and pelvis with IV contrast or CT enterography is usually appropriate for the imaging of a suspected intermittent or low-grade SBO with an indolent presentation. These procedures are equivalent alternatives (ie, only one procedure will be ordered to provide the clinical information to effectively manage the patient’s care). However, CT enterography could be performed as a complementary examination if small-
bowel distension aids in accentuating small-bowel pathology that is not initially evident on a CT without oral contrast.”

Expert Panel on Gastrointestinal Imaging et al. “ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction.” Journal of the American College of Radiology : JACR vol. 17,5S (2020): S305-S314. Full Text for Emory Users