Radiologic stigmata of SBO are the presence/coincidence of multiple air-fluid levels, dilatation/distension of small bowel loops and the absence of gas in the colonic section. Plain film has sensitivity

and specificity ranging from 65% to 80% [28]. Ultrasound can be useful only in expert hands; US is usually of limited value in bowel obstruction and/or in P005091 datasheet patients with distended bowel buy CAL-101 because the air, limiting ultrasound transmission, may obscure the underlying findings. The scan should be performed through flanks to avoid distended SB [29]. Usual US findings are: distention, peristalsis (differential diagnosis of ileus vs. mechanical SBO), differences in mucosal folds I-BET-762 around transition point, free fluid

(sign of ischemia) [30]. CT scan is highly diagnostic in SBO and has a great value in all patients with inconclusive plain films for complete or high grade SBO [31]. However CT-scans should not be routinely performed in the decision-making process except when clinical history, physical examination, and plain film are not conclusive for small bowel obstruction diagnosis [32]. CT can confirm the presence of complete obstruction and allow the diagnosis of the cause of SBO, it can also exclude a non-adhesional pathology and assess the occurrence of strangulation with a sensitivity and specificity higher than 90% and a NPV of nearly 100% [33]. IV contrast is necessary. Oral is not Water-soluble contrast follow-through is valuable in patients undergoing initial non operative conservative management in order to rule out complete ASBO and predict the need for surgery [34]. This investigation Niclosamide is safer than barium in cases of perforation and peritoneal spread

and has possible therapeutic value in the case of adhesive small intestine obstruction [35]. MRI use should be restricted to those patients having CT or iodine contrast contraindications. – Conservative treatment and timing for surgery The management of small bowel obstruction caused by adhesions is controversial because surgery can induce new adhesions, whereas conservative treatment does not remove the cause of the obstruction [36]. Conservative treatment involves nasogastric intubation, intravenous fluid administration, and clinical observation. Strangulation of the bowel requires immediate surgery, but intestinal ischemia can be difficult to determine clinically. Several issues are raised when managing patients with ASBO.