From the Guidelines
The abdominal X-ray findings of distended loops of bowel throughout the abdomen and pelvis suggest an ileus or bowel obstruction, which requires prompt medical attention, and a CT scan of the abdomen and pelvis is recommended for further evaluation and management, as it has been shown to have a diagnostic accuracy of more than 90% in detecting small-bowel obstruction 1. The patient should seek immediate medical care at an emergency department for proper evaluation and treatment. This condition typically requires hospital admission for management, which may include:
- Bowel rest (nothing by mouth)
- Intravenous fluids for hydration
- Nasogastric tube placement to decompress the stomach and intestines
- Pain management
- Close monitoring The underlying cause needs to be determined through additional imaging (such as CT scan) and laboratory tests. Treatment depends on the cause and severity - some cases resolve with conservative management while others may require surgery. These X-ray findings indicate that gas and fluid are building up in the intestines due to either decreased bowel motility (ileus) or a physical blockage (obstruction), which can lead to serious complications including bowel perforation, infection, or tissue death if not addressed promptly. Symptoms typically include abdominal pain, distension, nausea, vomiting, and inability to pass gas or stool. According to the American College of Radiology, a standard abdominal and pelvic CT examination is the most appropriate imaging modality for suspected small-bowel obstruction, as it provides high accuracy for distinguishing SBO from an adynamic small-bowel ileus and for identifying the cause of obstruction 1. In addition, CT with IV contrast is preferable for routine imaging of suspected SBO, as it demonstrates whether the bowel is perfusing normally or is potentially ischemic, and provides information about the potential etiology, such as Crohn disease and neoplasm 1.
From the Research
Abdominal X-ray Findings
- The abdominal x-ray reads "distended loops of bowel throughout the abdomen and pelvis, suggesting ileous/obstruction pattern"
- This pattern is indicative of a potential intestinal obstruction, which can be caused by various factors such as intra-abdominal adhesions, malignancy, or herniation 2
- The presence of distended loops of bowel and air-fluid levels can be seen in intestinal obstruction, as reported in a case study of a 30-year-old male patient with intestinal obstruction due to a congenital mesenteric band 3
Diagnostic Evaluation
- Computed tomography (CT) scan is the modality of choice for evaluating intestinal obstruction, as it can assess the bowel wall, supporting mesentery, and peritoneal cavity all in one 4
- CT scan can help identify the site and cause of obstruction, as well as rule out complications such as intestinal ischemia 4, 5
- Laboratory evaluation, including complete blood count, metabolic panel, and serum lactate level, can also aid in diagnosis and management 2
Management Options
- Management of uncomplicated obstructions includes intravenous fluid resuscitation, nasogastric decompression, and bowel rest 2
- Patients with fever and leukocytosis should receive antibiotic coverage against gram-negative organisms and anaerobes 2
- Subcutaneous neostigmine may be a reasonable option for managing ileus, acute colonic pseudo-obstruction, or refractory constipation, although it should be used with caution and monitoring for adverse effects 6
- Surgical intervention is indicated in cases of vascular compromise, perforation, or failure to resolve with nonoperative management 2