Acute abdominal series/es

Técnica

3 Películas:

1. Película de tórax de pie
   • Descartar aire libre
2. Película abdominal de pie
   • Buscar niveles líquido-aire
3. Película abdominal supina (KUB = solo película supina)
   • Anchura de las asas intestinales más visible (estimación de la cantidad de distensión)

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

Interpretation

• 

  Normal

• 

  Small bowel obstruction

• 

  Large bowel obstruction (Cecal volvulus; black arrows).

• 

  Free intra-abdominal air below the diaphragm.

• 

  Body-packing with multiple foreign bodies ("balls" of hashish).

• 

  Button battery in stomach.

• 

  Gallstones (not sensitive)

• 

  Toxic megacolon

• 

  Rectal foreign body

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

• Gallstones (not always radiodense)

See Also

• Abdominal pain