Acute abdominal series
Technique
3 Films:
- Upright chest film
- Rule-out free air
- Upright abdominal film
- Look for air-fluid levels
- 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
- Normal
- Large bowel obstruction (Cecal volvulus; black arrows).
- Free intra-abdominal air below the diaphragm.
- Body-packing with multiple foreign bodies ("balls" of hashish).
- Gallstones (not sensitive)
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
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