Nicolaou et G a s t ro i n t e s t i n a l I m ag i n g • P i c t o r i a l E s s ay

al.
Imaging of
Acute Small-
Bowel
Obstruction

Imaging of Acute
Small-Bowel Obstruction
Savvas Nicolaou1 OBJECTIVE. The objective of this pictorial essay is to review the different imaging tech-
Brian Kai2 niques used for diagnosing small-bowel obstruction.
Stephen Ho3 CONCLUSION. Small-bowel obstruction is a common presentation, for which safe and
Jenny Su4 effective management depends on a rapid and accurate diagnosis. Conventional radiographs re-
Karim Ahamed5 main the first line of imaging. CT is used increasingly more because it provides essential
diagnostic information not apparent from radiographs. MRI may play a role in the future as
Nicolaou S, Kai B, Ho S, Su J, Ahamed K technology improves and it becomes more readily available.
American Journal of Roentgenology 2005.185:1036-1044.

he morbidity and mortality associ- caused by slow resorption of intraluminal air

T ated with acute small-bowel ob-

DOI:10.2214/AJR.04.0815
Received May 24, 2004; accepted after revision
November 19, 2004.
1Department
of Radiology, Vancouver General Hospital,
899 W 12th Ave., Vancouver, BC, V5Z 1M9, Canada.
Address correspondence to S. Nicolaou
(snicolao@vanhosp.bc.ca).
2University of British Columbia, Vancouver, BC, Canada.
3Department of Radiology, Gastrointestinal Radiology,
Vancouver Hospital & Health Sciences Centre,
Vancouver, BC, Canada.
4Department
of Internal Medicine, University of British
Columbia, Vancouver, BC, Canada.
5Department of Diagnostic Radiology, University of Alberta,
Edmonton, AB, Canada.
AJR 2005;185:1036–1044
0361–803X/05/1854–1036
© American Roentgen Ray Society
struction continue to be signifi-
cant. It accounts for 12–16% of all
surgical admissions in patients with acute ab-
dominal conditions [1]. Small-bowel obstruc-
tion is caused by postoperative adhesions in
70% of all cases [2]. Other common causes in-
clude hernias, neoplasms, and Crohn’s disease
[1, 2]. The important question in small-bowel
obstruction management lies in determining
whether early laparotomy is required or
whether a trial of nonoperative management
should be instituted [1]. Clinical examination
findings and laboratory values are often non-
specific and unreliable at differentiating sim-
ple mechanical obstruction from strangulated
bowel. Imaging in the acute setting plays a key
role. It can indicate the location, degree, and
cause of an obstruction and assess for the pres-
ence of ischemia [3]. This pictorial essay aims
to review the various imaging techniques used
in establishing the diagnosis of acute small-
bowel obstruction.
Conventional Radiography
Abdominal radiography in conjunction with
the clinical examination is diagnostic in only
50–60% of cases [1]. Radiographs have been
shown to be sensitive for high-grade but not
low-grade obstructions [1]. Signs of small-
bowel obstruction on radiographs include dis-
tended loops of bowel greater than 3 cm, col-
lapsed colon, differential air–fluid levels, and
thickened bowel wall (Fig. 1). The string-of-
pearls sign may also be identified (Fig. 1). It is
leaving small bubbles trapped between the
folds of the valvulae conniventes. Except for
inguinal hernias [3] and gallstone ileus
(Fig. 2), the cause of obstruction is often indis-
cernible on radiographs. Strangulation may be
indicated by edematous folds, pneumatosis in-
testinalis (Fig. 3A), and gas in the portal vein
(Fig. 3B), but these features are rarely seen. If
a high clinical suspicion of obstruction exists,
additional imaging is required even if radio-
graphs are reported to show normal findings.
Despite its limitations, conventional radiogra-
phy continues to be the initial imaging exami-
nation for patients with suspected small-bowel
obstruction because of its sensitivity in reveal-
ing high-grade obstruction [1], wide availabil-
ity, and relatively low cost.
Contrast Studies
Oral contrast studies such as a small-bowel
follow-through can offer additional informa-
tion regarding the degree of obstruction. Find-
ings suggestive of obstruction include dilated
loops of small bowel and a delayed transit time
of barium through a transition point [3]. Limi-
tations of small-bowel follow-through include
the length of time required to perform the study,
dilution of barium because of excess residual
intraluminal fluid, and the inability of patients
to drink the barium in an acute setting [3].
Enteroclysis allows areas that are nondis-
tensible or fixed to be more easily identified
[4]. Enteroclysis is performed by intubating
the small bowel and infusing contrast mate-
rial, essentially bypassing the stomach. In the

1036 AJR:185, October 2005

 Imaging of Acute Small-Bowel Obstruction

Fig. 1—Small-bowel obstruction on radiography.

A, Supine abdominal radiograph in 45-year-old woman
with adhesional small-bowel obstruction shows
multiple dilated loops of small bowel. Valvulae
conniventes appear prominent. In appropriate clinical
context, this would be diagnostic of small-bowel
obstruction.
B, Upright abdominal radiograph in 56-year-old woman
with adhesional small-bowel obstruction shows
multiple air–fluid levels (arrows) and string-of-pearls
sign (arrowhead).

A B
American Journal of Roentgenology 2005.185:1036-1044.

Fig. 2—48-year-old woman presenting with gallstone ileus.

A, Upright abdominal radiograph shows multiple air–fluid levels. Pneumobilia (arrow) is present, as is string-of-
pearls sign (arrowheads).
B, CT scan through upper abdomen shows air in gallbladder (arrow) and proximal cystic duct.
C, CT scan obtained inferior to B shows calcified impacted gallstone (arrow) in distal jejunum with proximal dilated
loops of bowel.
A

B C

AJR:185, October 2005 1037


A B
American Journal of Roentgenology 2005.185:1036-1044.
subacute setting, enteroclysis is very accurate
in diagnosing low-grade and intermittent ob-
structions [4] and can serve as an adjunct to
CT if more information, such as how much
contrast material is making its way through
the obstruction, is required [4] (Fig. 4).
Sonography
On sonography, small-bowel obstruction is
suspected if multiple dilated (> 3 cm), fluid-
filled loops are seen (Fig. 5). The obstructing
cause can occasionally be visualized if it is a
tumor or hernia. The presence of aperistalsis,
fluid-filled bowel distention, and wall thick-
1038
Nicolaou et al.
Fig. 4—Enteroclysis. 54-year-old woman with adhesional small-bowel obstruction.
Spot film from enteroclysis shows small-bowel loop narrowing (arrow) due to
postoperative adhesion.
ening supports infarction in the appropriate
clinical context [5]. Bowel wall perfusion can
also be assessed by Doppler sonography.
Sonography has been reported to have a
sensitivity of 89% compared with 71% for
conventional abdominal radiography in diag-
nosing small-bowel obstruction and is supe-
rior in its ability to identify features of stran-
gulation and to predict the location and cause
of obstruction [5]. Although not routinely
used, sonography may be indicated in criti-
cally ill patients because transfer of the pa-
tient to the examination table may be time-
consuming and difficult [5].
Fig. 3—Strangulation.
A, Supine abdominal radiograph in 46-year-old woman
with ischemic colitis shows linear radiolucency
(arrows) along wall of bowel, which is consistent with
pneumatosis intestinalis. Dilated loops of small bowel
are also present.
B, Right-side-up decubitus abdominal radiograph in 69-
year-old woman shows multiple branching
radiolucencies (arrows) in periphery of liver shadow,
which is indicative of portal venous gas. Dilated loops
of small bowel are also present, which is consistent
with small-bowel obstruction.
CT
If an acute obstruction is suspected, CT is
the technique of choice for several reasons.
First, it does not require oral contrast mate-
rial because the retained intraluminal fluid
serves as a natural negative contrast agent.
Second, when compared with enteroclysis,
CT is rapid, noninvasive, and readily avail-
able [3]. Finally, it also allows extramural ar-
eas that would not be visible on contrast stud-
ies to be assessed.
The diagnosis of small-bowel obstruction
on CT involves identifying dilated loops of
bowel proximally with normal-caliber or
AJR:185, October 2005
 Imaging of Acute Small-Bowel Obstruction

A B
Fig. 5—Sonography features of small-bowel obstruction. Both cases are due to postoperative adhesions.
A, Abdominal sonogram in 40-year-old woman shows dilated, fluid-filled loop of small bowel with prominent valvulae conniventes (arrows).
B, Abdominal sonogram in 62-year-old man shows thickened small-bowel wall (arrows). Real-time scanning showed small bowel to be hyperperistaltic.
American Journal of Roentgenology 2005.185:1036-1044.

A B

Fig. 6—Small-bowel obstruction secondary to adhesions.

A, Axial CT scan through lower abdomen in 54-year-old woman with small-bowel
obstruction secondary to adhesions shows multiple fluid-filled loops of small bowel
(arrows).
B, CT scan obtained inferior to A shows transition point (arrows) with dilated bowel
proximally and collapsed bowel distally. No pathologic process is visualized at
transition point, and transition is smooth. This obstruction was found to be
adhesional in nature.
C, Axial contrast-enhanced CT scan through mid abdomen of 55-year-old man with
small-bowel obstruction secondary to adhesions shows multiple fluid-filled loops
with tapering transition point (arrows), otherwise known as beak sign.
C

AJR:185, October 2005 1039

 Nicolaou et al.

A B
Fig. 7—Small-bowel obstruction secondary to Crohn’s disease.
A, Axial CT scan through lower abdomen of 44-year-old woman with small-bowel obstruction secondary to Crohn’s disease shows multiple fluid-filled loops of small bowel
(arrows) and CT equivalent of string-of-pearls sign on radiography.
B, Axial CT scan through lower abdomen in 28-year-old woman with Crohn’s disease shows partially solid material intermixed with air within distal small bowel (arrows),
similar in appearance to feces in colon; this finding is called the “small-bowel feces” sign.
American Journal of Roentgenology 2005.185:1036-1044.

A B
Fig. 8—58-year-old woman with small-bowel obstruction secondary to adhesions.
A, Axial CT scan through lower abdomen shows dilated proximal loop (arrow) and collapsed distal loop (arrowhead).
B, CT scan obtained inferior to A shows narrowing of involved loop of bowel (arrows). Adhesion is inferred to be causing narrowing given history of previous abdominal
surgery and given neither masses nor extrinsic processes are seen to result in narrowing. Multiple dilated loops of small bowel are also seen.

Fig. 9—26-year-old woman with vasculitis and small-bowel obstruction. Axial

contrast-enhanced CT scan through mid abdomen shows thickened loops of small
bowel and target sign (arrows). Free fluid (arrowhead) is also seen.

1040 AJR:185, October 2005

 Imaging of Acute Small-Bowel Obstruction

A B
Fig. 10—66-year-old woman with diagnosis of ischemic bowel.
A, Axial contrast-enhanced CT scan through mid abdomen shows multiple dilated
air- and fluid-filled loops of small bowel. There is evidence of pneumatosis
American Journal of Roentgenology 2005.185:1036-1044.

intestinalis and lack of bowel wall enhancement (thin arrow) as compared with
normally enhancing loop (thick arrow). Also seen is intraperitoneal free fluid
(arrowhead). Round radiodensity seen in one loop of small bowel is surgical drain.
B, CT scan obtained inferior to A shows air in mesentery (arrowhead), and lack of
bowel wall enhancement (arrows) is again seen.
C, CT scan obtained superior to A shows air in intrahepatic portal venous vasculature
(arrow).

Fig. 11—57-year-old woman with small-bowel volvulus. Axial CT scan through upper
pelvis shows whirl sign (arrow) signifying volvulus. Volvulus can result if loop of
bowel is able to rotate around its mesentery. If loop sits in axial plane, it will appear
as ⊂ or ∪ shape. If orientation of loop is at right angle to axial plane, appearance will
vary depending on slice.

collapsed loops distally. A small-bowel cali- diagnosis is more certain [6]. The transition been shown to be present in 60% of simple
ber of greater than 2.5 cm is considered di- point often resembles a beak and is described small-bowel obstruction cases [7]. Other reli-
lated [6]. If a transition point is detected, the as the beak sign (Fig. 6). This finding has able features include the string-of-pearls sign

AJR:185, October 2005 1041


Fig. 12—64-year-old man with small-bowel obstruction secondary to incarcerated right inguinal hernia.
A, CT scan shows incarcerated right inguinal hernia resulting in small-bowel obstruction. Left and right arrows point to dilated loop of small bowel with engorged mesentery
(middle arrow).
B, Inferior transverse CT image obtained at level of symphysis pubis reveals incarcerated thick wall loop of small bowel within right inguinal canal (arrow).
American Journal of Roentgenology 2005.185:1036-1044.
Fig. 13—80-year-old man with small-bowel obstruction
secondary to adenocarcinoma of large bowel. Coronal
reformatted 2-mm-thick CT view of abdomen reveals
small-bowel obstruction is caused by thick annular
constricting mass lesion involving hepatic flexure of
large colon (thin arrows) resulting in proximal dilata-
tion of cecum (thick arrow) and small bowel (arrow-
heads). Pathology revealed colonic adenocarcinoma.
(Fig. 7A) and the “small-bowel feces” sign
(Fig. 7B). The small-bowel feces sign is a re-
sult of stasis and mixing of small-bowel con-
tents and is present in 82% of cases of small-
bowel obstruction [2, 3]. Occasionally, visu-
alization of an adhesional band is possible, al-
though it is rare to be able to do so (Fig. 8).
CT has a sensitivity of 81–94% and a spec-
ificity of 96% for diagnosing high-grade ob-
1042
Nicolaou et al.
A B
structions [2]. However, when all grades of
small-bowel obstructions are taken into ac-
count, the reliability of CT decreases dramat-
ically (sensitivity of 64% and specificity of
79%) [2]. Therefore, CT is not the ideal tech-
nique for diagnosis of low-grade or subacute
obstructions and should be complemented by
a contrast study, ideally enteroclysis [6].
The most important information that CT
can provide the surgeon is whether there is an
associated strangulation. The sensitivity of
contrast-enhanced CT for intestinal ischemia
has been reported to be as high as 90% [1].
There are various signs that have been associ-
ated with ischemia [3, 7], although their use-
fulness is debatable. These include, first,
thickened bowel wall (Fig. 9); second, ascites
(Fig. 9); third, the target sign, a trilaminar ap-
pearance of the bowel wall resulting from IV
contrast enhancement of the mucosal and
muscularis layers, plus submucosal edema
(Fig. 9); fourth, poor or absent enhancement
of bowel wall on IV contrast-enhanced scans
(Figs. 10A and 10B); fifth, pneumatosis in-
testinalis and gas in mesenteric or portal veins
(Fig. 10C); sixth, the whirl sign, a twisting of
the mesenteric vasculature signifying a vol-
vulus (Fig. 11); seventh, tortuous engorged
mesenteric vessels (Fig. 12A); eighth, mesen-
teric hemorrhage; and, finally, increased at-
tenuation of bowel wall on noncontrast scans.
Although these signs are individually in-
sufficiently sensitive, they are quite sugges-
tive of ischemia when used together [7]. CT is
also useful in differentiating small-bowel ob-
struction from ileus and determining the
cause of obstruction (Figs. 11 and 12).
Multiplanar reformations are now being
used in difficult cases. Multiplanar views may
help identify the site, level, and cause of ob-
struction when axial findings are indetermi-
nate [7] (Figs. 13 and 14). CT enteroclysis, a
relatively new investigational tool for diag-
nosing small-bowel obstruction, can also be
used with multiplanar reconstructions to
overcome the unreliability of CT for diagnos-
ing low-grade obstructions. CT enteroclysis
has a greater sensitivity and specificity (89%
and 100%, respectively) than CT alone (50%
and 94%, respectively) [1]. At the same time,
the 3D imaging provides precise localization
of the pathology [1].
MRI
MRI provides rapid, accurate identification
of small-bowel obstruction [8] and assists in
the determination of cause without exposing
the patient to radiation. MRI also utilizes in-
traluminal air as a natural contrast agent and is
not limited by previous administration of bar-
ium. The diagnosis of small-bowel obstruction
on MRI is similar to CT and involves identify-
ing dilated loops of bowel proximal to the ob-
struction, a distinct transition point, and nor-
mal-caliber or collapsed bowel distally.
Multiplanar capabilities of MRI allow visual-
ization of the cause of small-bowel obstruction
(Fig. 15). Rapid scanning with MRI using the
HASTE sequence can, within seconds, evalu-
ate small-bowel obstruction with a high degree
AJR:185, October 2005
 Imaging of Acute Small-Bowel Obstruction

Fig. 14—49-year-old man

with incarcerated
abdominal hernia.
A, Axial CT scan shows
defect in lower
abdominal wall (arrow)
that has incarcerated
lower abdominal hernia
within it (arrowhead).
B, Sagittal reformatted
MDCT view depicts
defect in lower abdomi-
nal wall (long thick
arrow) and incarcerated
lower abdominal hernia.
Within hernia sac, thick
wall loop of small bowel
and free fluid (arrow-
head) are noted with
dilated loops of small
bowel proximal (short
thick arrow) to incarcer-
ated small-bowel loop.
Free fluid (star and thin
arrow) is also present in
abdomen, which is an
associated finding in
American Journal of Roentgenology 2005.185:1036-1044.

small-bowel obstruction.
A B

Fig. 15—80-year-old man

with small-bowel
obstruction secondary to
adenocarcinoma of large
bowel.
A, Transverse
gadolinium-enhanced
T1-weighted image
(TR/TE, 400/10) obtained
with fat saturation shows
narrowing of large bowel
(arrow) caused by mass
(small arrowhead) with
B resultant proximal small-
bowel obstruction (large
arrowhead).
A B, Coronal single-shot
fast spin-echo T2-
weighted image
(1,800/103) reveals same
constricting mass seen
in A but with intermediate
signal (thin arrows).
Resultant proximal
dilatation of large (thick
arrow) and small
(arrowheads) bowel is
visualized.
C, Subsequent coronal
image reveals numerous
proximal dilated loops of
small bowel (arrows),
which is consistent with
diagnosis of small-bowel
obstruction.
C

AJR:185, October 2005 1043


of accuracy [8]. Furthermore, it avoids artifacts
related to peristalsis and breathing that have
limited the diagnostic yield of MRI in small-
bowel obstruction in the past [8]. MRI is un-
likely to replace CT for evaluating small-
bowel obstruction because of longer scanning
time and inferior resolution [8]; however, as
availability and technology in MRI continues
to improve, it has the potential to be an excel-
lent diagnostic method for evaluating small-
bowel obstruction.
Conclusion
Small-bowel obstruction is a common pre-
sentation, for which safe and effective man-
agement depends on rapid and accurate diag-
nosis. Imaging can be diagnostic and helpful in
guiding management. Abdominal radiography
remains the first-line imaging examination be-
American Journal of Roentgenology 2005.185:1036-1044.
1044
Nicolaou et al.
cause it is readily available, is cheap, and can
be done serially to follow clinical progression.
CT can provide additional information such as
confirmation of an obstruction, degree and site
of an obstruction, presence of ischemia, and
the cause of the obstruction. MRI may have a
role in the future evaluation of small-bowel ob-
struction as the technology improves and it in-
creases in availability.
References
1. Maglinte DDT, Heitkamp DE, Howard TJ, et al.
Current concepts in imaging of small bowel ob-
struction. Radiol Clin North Am 2003; 41:263–283
2. Burkill GJC, Bell JRG, Healy JC. The utility of
computed tomography in acute small bowel ob-
struction. Clin Radiol 2001; 56:350–359
3. Macari M, Megibow A. Imaging of suspected acute
small bowel obstruction. Semin Roentgenol 2001;
36:108–117
4. Maglinte DDT, Balthazar EJ, Kelvin FM, Megibow
AJ. The role of radiology in the diagnosis of small-
bowel obstruction. AJR 1997; 168:1171–1180
5. Schmutz GR, Benko A, Fournier L, et al. Small
bowel obstruction: role and contribution of sonog-
raphy. Eur Radiol 1997; 7:1054–1058
6. Furukawa A, Yamasaki M, Furuichi K, et al. Helical
CT in the diagnosis of small bowel obstruction. Ra-
dioGraphics 2001; 21:341–355
7. Ha HH, Kim JS, Lee MS, et al. Differentiation of
simple and strangulated small bowel obstructions:
usefulness of known CT criteria. Radiology 1997;
204:507–512
8. Regan F, Beall DP, Bohlman ME, Khazan R,
Sufi A, Schaefer DC. Fast MR imaging and the
detection of small-bowel obstruction. AJR 1998;
170:1465–1469
AJR:185, October 2005
 This article has been cited by:

1. Abdulmalik Dredar, Prem Thanaratnam, Kaiser Hussain, Seth Andrews, Edward Mtui, Tara Catanzano. 2017. Acute Bowel
Computed Tomography. Seminars in Ultrasound, CT and MRI 38:4, 399-413. [Crossref]
2. Daniel J. Ohngemach, Yonah B. Esterson, Naeem Rahman, Ali Noor, John S. Pellerito. 2016. Unexpected Findings During
Evaluation of Acute Pelvic Pain With Transvaginal Sonography. Journal of Ultrasound in Medicine 35:12, 2687-2696. [Crossref]
3. Ryan A. Makar, Mustafa R. Bashir, Clare M. Haystead, Christine Iseman, Nicholas Mayes, Stuart Hebert, Brian C. Allen, Syamal
D. Bhattacharya, Kingshuk R. Choudhury, Tracy A. Jaffe. 2016. Diagnostic performance of MDCT in identifying closed loop
small bowel obstruction. Abdominal Radiology 41:7, 1253-1260. [Crossref]
4. Nazanin Ahmadi, Johan G. Blickman. The Small Bowel 209-236. [Crossref]
5. Claudia Rossi, Mariateresa Martino, Roberto Ronza, Roberto Rizzati, Mariano Scaglione. Imaging in Emergency Surgery 203-230.
[Crossref]
6. Richard M. Gore, Robert I. Silvers, Kiran H. Thakrar, Daniel R. Wenzke, Uday K. Mehta, Geraldine M. Newmark, Jonathan
W. Berlin. 2015. Bowel Obstruction. Radiologic Clinics of North America 53:6, 1225-1240. [Crossref]
7. Kevin P. Murphy, Maria Twomey, Patrick D. McLaughlin, Owen J. O’Connor, Michael M. Maher. 2015. Imaging of Ischemia,
Obstruction and Infection in the Abdomen. Radiologic Clinics of North America 53:4, 847-869. [Crossref]
8. Narisha Maharaj, Bhugwan Singh. 2015. A review of the radiological imaging modalities of non-traumatic small bowel obstruction.
South African Family Practice 57:3, 146-159. [Crossref]
9. Erik K. Paulson, William M. Thompson. 2015. Review of Small-Bowel Obstruction: The Diagnosis and When to Worry.
American Journal of Roentgenology 2005.185:1036-1044.

Radiology 275:2, 332-342. [Crossref]

10. Tunc Eren, Salih Boluk, Baris Bayraktar, Ibrahim Ali Ozemir, Sumeyra Yildirim Boluk, Ercument Tombalak, Orhan Alimoglu.
2015. Surgical indicators for the operative treatment of acute mechanical intestinal obstruction due to adhesions. Annals of Surgical
Treatment and Research 88:6, 325. [Crossref]
11. Kazuaki Nakashima, Hideki Ishimaru, Toshifumi Fujimoto, Takashi Mizowaki, Kazunori Mitarai, Kei Nakashima, Yohjiro
Matsuoka, Masataka Uetani. 2014. Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-
bowel obstruction. Abdominal Imaging . [Crossref]
12. Arvind Srinath, Erin Young, Eva Szigethy. 2014. Pain Management in Patients with Inflammatory Bowel Disease. Inflammatory
Bowel Diseases 20:12, 2433-2449. [Crossref]
13. Francesca Iacobellis, Daniela Berritto, Maria Paola Belfiore, Imma Di Lanno, Manuela Maiorino, Luca Saba, Roberto Grassi. 2014.
Meaning of Free Intraperitoneal Fluid in Small-Bowel Obstruction. Journal of Ultrasound in Medicine 33:5, 887-893. [Crossref]
14. Lorene E. Romine, Randy Fanous, Michael J. Gabe, Richard C. Semelka, Michele A. Brown. Imaging Maternal Conditions in
Pregnancy 131-179. [Crossref]
15. Katsumi Hayakawa, Masato Tanikake, Shoko Yoshida, Akira Yamamoto, Eiji Yamamoto, Taisuke Morimoto. 2013. CT findings
of small bowel strangulation: the importance of contrast enhancement. Emergency Radiology 20:1, 3-9. [Crossref]
16. Muhammad Idris, Nazia Kashif, Sidra Idris, Wasim Ahmad Memon, Ul-Haq Tanveer, Zishan Haider. 2012. Accuracy of 64-slice
multidetector computed tomography scan in detection of the point of transition of small bowel obstruction. Japanese Journal of
Radiology 30:3, 235-241. [Crossref]
17. Taro Takahara, Thomas C. Kwee, Sotaro Sadahiro, Tomohiro Yamashita, Yuki Toyoguchi, Takeshi Yoshizako, Tomohiro Horie,
Peter R. Luijten, Yutaka Imai. 2011. Low b-value diffusion-weighted imaging for diagnosing strangulated small bowel obstruction:
A feasibility study. Journal of Magnetic Resonance Imaging 34:5, 1117-1124. [Crossref]
18. AJAY SHARMA, MARGRET S. THOMPSON, PETER V. SCRIVANI, NATHAN L. DYKES, AMY E. YEAGER, SEAN R.
FREER, HOLLIS N. ERB. 2011. COMPARISON OF RADIOGRAPHY AND ULTRASONOGRAPHY FOR DIAGNOSING
SMALL-INTESTINAL MECHANICAL OBSTRUCTION IN VOMITING DOGS. Veterinary Radiology & Ultrasound 52:3,
248-255. [Crossref]
19. Geoffrey E. Hayden, Kevin L. Sprouse. 2011. Bowel Obstruction and Hernia. Emergency Medicine Clinics of North America 29:2,
319-345. [Crossref]
20. Benjamin T. Jarman. 2011. Small Bowel Imaging. Surgical Clinics of North America 91:1, 109-125. [Crossref]
21. Maryam Rezvani, Vahid Yaghmai. CT of the Small Bowel 290-295. [Crossref]
22. Taro Takahara, Thomas C. Kwee, Hiroki Haradome, Kei Aoki, Hiroyoshi Matsuoka, Akihisa Nakamura, Keita Honya, Mitsuyuki
Takahashi, Tomohiro Yamashita, Peter R. Luijten, Yutaka Imai. 2011. Peristalsis gap sign at cine magnetic resonance imaging
for diagnosing strangulated small bowel obstruction: feasibility study. Japanese Journal of Radiology 29:1, 11-18. [Crossref]
 23. Joshua Broder. Imaging of Nontraumatic Abdominal Conditions 445-577. [Crossref]
24. Kyung Mi Jang, Kwangseon Min, Min Jeong Kim, Sung Hye Koh, Eui Yong Jeon, In-Gyu Kim, Dongil Choi. 2010. Diagnostic
Performance of CT in the Detection of Intestinal Ischemia Associated With Small-Bowel Obstruction Using Maximal Attenuation
of Region of Interest. American Journal of Roentgenology 194:4, 957-963. [Abstract] [Full Text] [PDF] [PDF Plus]
25. Colleen Trevino. 2010. Small Bowel Obstruction. AACN Advanced Critical Care 21:2, 187-194. [Crossref]
26. . Bowel Obstruction 956-958. [Crossref]
27. Susan P. Torrey, Philip L. Henneman. Disorders of the Small Intestine 1184-1192. [Crossref]
28. Karis Tekwani, Rishi Sikka. 2009. High-Risk Chief Complaints III: Abdomen and Extremities. Emergency Medicine Clinics of
North America 27:4, 747-765. [Crossref]
29. Gopal Vijayaraghavan, Divya Kurup, Ajay Singh. 2009. Imaging of Acute Abdomen and Pelvis: Common Acute Pathologies.
Seminars in Roentgenology 44:4, 221-227. [Crossref]
30. Ana Catarina Silva, Madalena Pimenta, Luis S Guimaraes. 2009. Small Bowel Obstruction: What to Look For. RadioGraphics
29:2, 423-439. [Crossref]
31. OG Gümüştaş, A Gümüştaş, R Yalçın, G Savcı, RA Soylu. 2008. Unusual causes of small bowel obstruction and contemporary
diagnostic algorithm. Journal of Medical Imaging and Radiation Oncology 52:3, 208-215. [Crossref]
32. Cheng-Jui Lin, Chyou-Shen Lee, Hsiang-Kuang Tseng, Yuan-ching Chang. 2008. Mechanical Bowel Strangulation Mimicking
Mesenteric Vasculitis in a Systemic Lupus Erythematosus Patient. Southern Medical Journal 101:4, 436-438. [Crossref]
33. Nancy A. Hammond, Frank H. Miller, Vahid Yaghmai, Dava Grundhoefer, Paul Nikolaidis. 2008. MR imaging of acute bowel
pathology: a pictorial review. Emergency Radiology 15:2, 99-104. [Crossref]
American Journal of Roentgenology 2005.185:1036-1044.

34. R. Hyland, A. Chalmers. 2007. CT features of jejunal pathology. Clinical Radiology 62:12, 1154-1162. [Crossref]
35. A J Crowther, J M McMaster, J Abercrombie, D M Hahn. 2006. Sacral Fracture Associated with Small Bowel Entrapment: A
Case Report. Journal of Orthopaedic Trauma 20:8, 580-583. [Crossref]