Preliminary Diagnosis: Ileus
I. What imaging technique is first-line for this diagnosis?
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Plain abdominal radiography
II. Describe the advantages and disadvantages of this technique for diagnosis of an ileus.
Advantages
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Quick, efficient, and cost-effective modality to evaluate for an ileus
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Uses less ionizing radiation than CT imaging and fluoroscopy
Disadvantages
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May not be able to localize a primary abdominal or pelvic inflammatory or infectious process that causes a secondary ileus
III. What are the contraindications for the first-line imaging technique?
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No significant contraindications to plain radiography exist.
IV. What alternative imaging techniques are available?
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Nonenhanced CT
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Fluoroscopy
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Upper GI examination
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Contrast enema
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of an ileus.
CT without contrast
Advantages
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May help evaluate for a partial obstruction and localize a transition point where the differential includes a dynamic ileus versus partial bowel obstruction
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May localize a primary abdominal or pelvic inflammatory process that may elicit a secondary dynamic ileus so that the primary process may be treated
Disadvantages
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Exposes the patient to much more ionizing radiation when compared to plain radiography
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Patients susceptible to more motion artifact as CT imaging scan times are longer than plain radiography
Fluoroscopy
Advantages
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Able to evaluate for a mechanical obstructing upper gastrointestinal lesion as contrast propagates distally
Disadvantages
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Exposes the patient to more ionizing radiation than plain radiography
Upper GI examination
Advantages
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Ingestion of oral contrast is patient dependent and may be time-consuming in noncooperative patients.
Disadvantages
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A normal upper GI examination may not rule out a distal bowel obstruction.
Contrast enema
Advantages
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Contrast enema may be therapeutic and stimulate bowel peristalsis.
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Normal contrast enema may rule out colonic mechanical obstruction.
Disadvantages
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Normal contrast enema may not rule out upper GI obstruction.
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Contrast enema examinations are painful and irritating as the contrast causes colonic distention.
VI. What are the contraindications for the alternative imaging techniques?
CT without contrast
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Contraindicated in pregnant patients, especially within the first two trimesters
Fluoroscopy
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Contraindicated in pregnant patients, especially within the first two trimesters
Upper GI examination
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Upper GI and contrast enema examination are contraindicated in patients with esophageal, stomach, or bowel perforation and associated free air
Contrast enema
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Contraindicated in patients with esophageal, stomach, or bowel perforation
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