What Investigations Are Required in Assessing Bowel Obstruction?
The full diagnostic workup is shown in Box 1, and Figure 1 shows a flow diagram for diagnostic assessment of bowel obstruction. The usual sequence of investigations starts with plain abdominal X-ray (see Figure 1). In the absence of grossly distended bowel loops on X-ray, and if the patient’s condition is stable, ultrasound can be useful to rule out (1) other conditions or diseases causing paralytic ileus or (2) the presence of intraperitoneal free fluid. If the plain abdominal X-ray shows air fluid levels and grossly distended bowel loops, the level and possible site of obstruction must be assessed (i.e., small bowel or large bowel), and the further diagnostic workup proceeds accordingly. When in doubt, or when the clinical and radiological findings are not clear enough to suggest the best further diagnostic steps, abdominal computed tomography (CT) scan may be helpful, with the eventual adjunct of triple contrast (intravenous, oral, and/or rectal). The last diagnostic options are dia
