Acute abdominal series: Difference between revisions

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File:Medical X-Ray imaging ALP02 nevit.jpg|Normal
File:Medical X-Ray imaging ALP02 nevit.jpg|Normal
File:SBO plain.png|[[Small bowel obstruction]]
File:SBO plain.png|[[Small bowel obstruction]]
File:Free air under diaphram.png|Upright chest radiograph demonstrating free intra-abdominal air below the diaphragm. (Black arrows demonstrate the air below the diaphragm)
File:Cecalvolvulus.png|Large bowel obstruction (Cecal [[volvulus]]) left upper quadrant (black arrows), with small bowel obstruction (white arrows).
File:Cecalvolvulus.png|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.
File:Free air under diaphram.png|Free intra-abdominal air below the diaphragm.
File:Abdominal foreign body.png|Multiple foreign bodies in the bowel; body-packing with multiple "balls" of hashish.
File:Abdominal foreign body.png|Body-packing with multiple foreign bodies ("balls" of hashish).
File:Battery in stomach.png|Button battery foreign body in the stomach.
File:Battery in stomach.png|Button battery in stomach.


Revision as of 19:37, 4 May 2015


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



Differentiating 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

Bowel Diameters: 3/6/9 rule

  • Small bowel - 3 cm
  • Colon - 6 cm
  • 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


  1. Ruling out free air under the diaphragm (e.g. perforated ulcer)
  2. Ruling out radio-opaque abdominal foreign body
  3. Ruling in bowel obstruction (i.e. to avoid need for 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")

See Also