What is the appropriate investigation for a 65-year-old male patient with a history of right hemicolectomy (surgical removal of the right side of the colon) for cecal (part of the large intestine) cancer, presenting with abdominal pain, vomiting, and abdominal distension one year post-operatively?

From the Guidelines

The most appropriate investigation for this patient is a Small bowel series, as it can help visualize the site and cause of the suspected small bowel obstruction. This patient's presentation suggests a possible small bowel obstruction, which is a common complication following abdominal surgery due to adhesions, as discussed in the study by 1. Given his history of previous abdominal surgery and current symptoms of obstruction (pain, vomiting, distension), a small bowel series would be the most useful initial investigation. The symptoms presented by the patient, such as abdominal pain, vomiting, and distension, are consistent with a small bowel obstruction, as described in the study by 1. Some key points to consider in this case include:

• The patient's history of abdominal surgery, which increases the risk of adhesions and subsequent small bowel obstruction, as mentioned in the study by 1.
• The presence of abdominal distension and vomiting, which are common symptoms of small bowel obstruction, as discussed in the study by 1.
• The soft, lax abdomen, which suggests that the obstruction may be partial rather than complete, making non-surgical diagnostic approaches appropriate initially, as indicated in the study by 1. Other options, such as Barium enema, Colonoscopy, and Laparotomy, are less suitable as initial investigations for this patient. Barium enema would be less useful since the patient had a right hemicolectomy and the symptoms suggest small bowel rather than colonic pathology, as discussed in the study by 1. Colonoscopy is not indicated in acute obstruction and could potentially worsen the condition, as mentioned in the study by 1. Laparotomy is too invasive as a first-line diagnostic approach when non-surgical imaging options are available, as indicated in the study by 1. The study by 1 provides further guidance on the management of adult patients with severe chronic small intestinal dysmotility, but the patient's presentation suggests an acute rather than chronic condition. Overall, a Small bowel series is the most appropriate initial investigation for this patient, as it can provide valuable information about the site and cause of the suspected small bowel obstruction, and guide further management, as discussed in the study by 1.

From the Research

Appropriate Investigation for Small Bowel Obstruction

The patient's symptoms of abdominal pain, vomiting, and distended abdomen suggest a possible small bowel obstruction. The appropriate investigation for this condition is:

• Computed Tomography (CT) scan, as it is a powerful tool for assessing patients with small bowel obstruction 2, 3
• CT can provide important information about the cause and site of obstruction, as well as the presence of a closed-loop obstruction or ischemia 2
• CT is considered the preeminent imaging modality for evaluating patients with suspected high-grade small-bowel obstruction 4

Alternative Investigations

Other investigations, such as:

• Barium enema, may play a less significant role in the diagnosis of acute small-bowel obstruction 4
• Small bowel series, may be used in certain cases, but CT is generally preferred 5, 4
• Colonoscopy, is not typically used for diagnosing small bowel obstruction
• Laparotomy, may be necessary in some cases, but it is not typically the first line of investigation

Imaging Findings

Imaging findings, such as:

• Normal to rapid transit time to the point of obstruction
• Homogenous dilution of barium in dilated proximal loops
• Inhomogenous, scattered, and fragmented collections of barium in the distal, collapsed loops, can be indicative of small bowel obstruction 5