Acute abdominal series: Difference between revisions
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==Background==
<languages/>
*Differs from KUB in that patient is upright vs supine on KUB
<translate>


==Diagnosis==
==Technique== <!--T:1-->
[[File:Medical X-Ray imaging ALP02 nevit.jpg|thumb|Normal]]
 
[[File:SBO plain.png|thumb|[[Small bowel obstruction]]]]
<!--T:2-->
[[File:Free air under diaphram.png|thumb|Upright chest radiograph demonstrating free intra-abdominal air below the diaphragm. (Black arrows demonstrate the air below the diaphragm)]]
3 Films:
[[File:Cecalvolvulus.png|thumb|Cecal [[volvulus]]. Featureless dilated gas filled viscus, representing the volved caecum, in the left upper quadrant (black arrows) and small bowel obstruction (white arrows). No colonic gas is identified.]]
#Upright chest film
[[File:Abdominal foreign body.png|thumb|Multiple foreign bodies in the bowel; body-packing with multiple "balls" of hashish.]]
#*Rule-out free air
*Films
#Upright abdominal film
**Upright chest film: r/o free air
#*Look for air-fluid levels
**Upright abd film: air-fluid levels
#Supine abdominal film (''KUB = just supine film'')
**Supine abd film: width of bowel loops most visible (estimate of amount of distention)
#*Width of bowel loops most visible (estimate of amount of distention)
 
<!--T:3-->
''If patient does not tolerate upright position, left lateral decubitus abdominal film can substitute''
 
 
==Interpretation== <!--T:4-->
 
<!--T:5-->
<gallery mode="packed">
File:Medical X-Ray imaging ALP02 nevit.jpg|Normal
File:SBO plain.png|[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]
File:Cecalvolvulus.png|Large bowel obstruction (Cecal [[Special:MyLanguage/volvulus|volvulus]]; black arrows).
File:Free air under diaphram.png|Free intra-abdominal air below the diaphragm.
File:Abdominal foreign body.png|Body-packing with multiple foreign bodies ("balls" of hashish).
File:Battery in stomach.png|[[Special:MyLanguage/Esophageal foreign body|Button battery in stomach.]]
File:StonesXray.png|[[Special:MyLanguage/Gallstones|Gallstones]] (not sensitive)
File:Toxisches Megacolon bei Colitis ulcerosa.jpg|[[Special:MyLanguage/Toxic megacolon|Toxic megacolon]]
File:Rectal_fb.JPG|[[Special:MyLanguage/Rectal foreign body|Rectal foreign body]]
</gallery>
 
 
===Differentiating large and small bowel=== <!--T:6-->
 
<!--T:7-->
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Location'''
| align="center" style="background:#f0f0f0;"|'''Size'''
| align="center" style="background:#f0f0f0;"|'''Lines'''
|-
| Small bowel||3 cm||All the way through the bowel (plica circulares)
|-
| Colon||6 cm||Only halfway through the bowel (haustra)
|-
| Cecum||9 cm||
|}
 
 
===[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]=== <!--T:8-->
 
<!--T:9-->
*Air in colon or rectum makes complete obstruction less likely (esp if symptoms >24hr)
*Air in colon or rectum makes complete obstruction less likely (esp if symptoms >24hr)
*If pt does not tolerate upright position left lateral decub abd film can substitute
*Abdominal x-ray has poor Sn and Sp for [[Special:MyLanguage/SBO|SBO]]
**If concerned need CT
 
 
==Indications== <!--T:10-->
 
<!--T:11-->
*Ruling out free air under the diaphragm (e.g. perforated ulcer)
*Ruling out radio-opaque abdominal foreign body (e.g. swallowed battery)
*Ruling '''in''' bowel obstruction (i.e. to avoid need for subsequent CT scan)


<!--T:12-->
;Do NOT use as the sole study to rule out bowel obstruction (poor sensitivity)
;Do NOT use to rule out generalized peritonitis (almost no sensitivity for diagnoses such as [[Special:MyLanguage/appendicitis|appendicitis]])
;Do NOT use to diagnose constipation (many patient with acute abdomen will have "copious stool")


To differentiate large and small bowel:
*Small bowel has lines (plica circulares) all the way through the bowel
*Large bowel has lines (haustra) only halfway through the bowel


==Incidental findings== <!--T:13-->


Bowel Diameters: 3/6/9 rule
<!--T:14-->
*Small bowel - 3 cm
*[[Special:MyLanguage/Gallstones|Gallstones]] (not always radiodense)
*Colon - 6 cm
*Cecum - 9 cm




Abdominal x-ray has poor Sn and Sp for SBO
==See Also== <!--T:15-->
*If concerned need CT


==See Also==
<!--T:16-->
*[[SBO]]
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]


<!--T:17-->
[[Category:GI]]
[[Category:GI]]
[[Category:Rads]]
[[Category:Radiology]]
</translate>

Latest revision as of 16:57, 6 January 2026

Other languages:
  • English

Technique

3 Films:

  1. Upright chest film
    • Rule-out free air
  2. Upright abdominal film
    • Look for air-fluid levels
  3. Supine abdominal film (KUB = just supine film)
    • Width of bowel loops most visible (estimate of amount of distention)

If patient does not tolerate upright position, left lateral decubitus abdominal film can substitute


Interpretation


Differentiating large and small bowel

Location Size Lines
Small bowel 3 cm All the way through the bowel (plica circulares)
Colon 6 cm Only halfway through the bowel (haustra)
Cecum 9 cm


Small bowel obstruction

  • Air in colon or rectum makes complete obstruction less likely (esp if symptoms >24hr)
  • Abdominal x-ray has poor Sn and Sp for SBO
    • If concerned need CT


Indications

  • Ruling out free air under the diaphragm (e.g. perforated ulcer)
  • Ruling out radio-opaque abdominal foreign body (e.g. swallowed battery)
  • Ruling in bowel obstruction (i.e. to avoid need for subsequent CT scan)
Do NOT use as the sole study to rule out bowel obstruction (poor sensitivity)
Do NOT use to rule out generalized peritonitis (almost no sensitivity for diagnoses such as appendicitis)
Do NOT use to diagnose constipation (many patient with acute abdomen will have "copious stool")


Incidental findings


See Also

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