Evaluation of X-Ray Evidence as Criteria of Intestinal Obstruction

Abstract

Late diagnoses in simple obstruction of the bowel are due in large measure to the absence of local physical findings which help in other abdominal disasters to corroborate the suspicion that a surgical emergency obtains. The usual textbook description of the physical findings in intestinal obstruction is an ante mortem picture. Regurgitant vomiting and abdominal distension are heralds of death and not physical findings significant of the presence of acute bowel obstruction.

The employment of the X-ray to detect bowel obstruction was suggested about 20 years ago, but it is not widely used for this purpose today and several recent writers state that the employment of X-rays is of no value in the diagnosis of obstruction. In this study an attempt has been made to evaluate the X-ray criteria in the early recognition of bowel obstruction.

Normally gas exists throughout the entire intestinal tract, but when an X-ray film is made of the abdomen, gas is discernible only in the stomach and colon, and especially at the flexures. Its intimate admixture with fluid in the small intestine precludes its demonstration on the X-ray film, though tiny bubbles are constantly present at least in portions of the small intestine. The accumulation of the gas in the small intestine is therefore proof of the existence of delay in transit of the content through the small intestine and usually means intestinal stasis.

In this study simple obstruction was established in 20 dogs; 16 of these were complete, the bowel being severed and the ends inverted. In the other 4, partial obstructions were established by ligating the bowel with gauze. Seventeen dogs were obstructed in the lower one-third of the small intestine and 3 were in the sigmoid.