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Small-Bowel Obstruction: Coronal Reformations from Isotropic Voxels at 16-Section Multi–Detector Row CT¹

¹ From the Department of Radiology, Duke University Medical Center, Erwin Rd, Box 3808, Durham, NC 27710. Received March 23, 2005; revision requested May 13; revision received June 23; final version accepted July 18. Supported in part by GE Healthcare. Address correspondence to T.A.J. (e-mail: jaffe002{at}mc.duke.edu).

View larger version (156K): [in a new window]   Figure 1a: CT scans in a 78-year-old woman with acute abdominal pain. (a) Transverse CT scan obtained with intravenous and oral contrast agents shows dilated proximal small-bowel loops. (b) Coronal reformation shows dilated small-bowel loops with a transition point (arrow) in the midabdomen.

View larger version (164K): [in a new window]   Figure 1b: CT scans in a 78-year-old woman with acute abdominal pain. (a) Transverse CT scan obtained with intravenous and oral contrast agents shows dilated proximal small-bowel loops. (b) Coronal reformation shows dilated small-bowel loops with a transition point (arrow) in the midabdomen.

View larger version (145K): [in a new window]   Figure 2a: CT scans in a 36-year-old woman with a 36-hour history of nausea and vomiting. (a) Transverse CT scan obtained with intravenous and oral contrast agents demonstrates multiple dilated loops of proximal small bowel (black arrow) with inflammatory mass (white arrow) in right lower quadrant, in the region of the cecum. (b) Coronal CT scan shows small-bowel dilatation leading to an inflammatory mass involving the cecum. The point of obstruction (arrow) is at the level of the cecum. Examination of subsequent biopsy specimen of this mass demonstrated adenocarcinoma.

View larger version (182K): [in a new window]   Figure 2b: CT scans in a 36-year-old woman with a 36-hour history of nausea and vomiting. (a) Transverse CT scan obtained with intravenous and oral contrast agents demonstrates multiple dilated loops of proximal small bowel (black arrow) with inflammatory mass (white arrow) in right lower quadrant, in the region of the cecum. (b) Coronal CT scan shows small-bowel dilatation leading to an inflammatory mass involving the cecum. The point of obstruction (arrow) is at the level of the cecum. Examination of subsequent biopsy specimen of this mass demonstrated adenocarcinoma.

View larger version (114K): [in a new window]   Figure 3a: CT scans in a 50-year old man with severe abdominal pain and no fever. (a) Transverse CT scan of upper abdomen obtained with intravenous and oral contrast agents shows multiple dilated loops of proximal small bowel. (b) Transverse CT scan in the pelvis shows decompressed loops (arrow) of distal small bowel. The caliber change indicates an SBO. (c) Transverse CT scan obtained at the level of pubic symphysis shows incarcerated small bowel in right inguinal hernia (arrow). (d) CT coronal reformation shows the incarcerated small-bowel loop (arrow) in the right groin. This is the level of the transition point, and all readers were confident of the diagnosis of SBO on both transverse and coronal scans.

View larger version (113K): [in a new window]   Figure 3b: CT scans in a 50-year old man with severe abdominal pain and no fever. (a) Transverse CT scan of upper abdomen obtained with intravenous and oral contrast agents shows multiple dilated loops of proximal small bowel. (b) Transverse CT scan in the pelvis shows decompressed loops (arrow) of distal small bowel. The caliber change indicates an SBO. (c) Transverse CT scan obtained at the level of pubic symphysis shows incarcerated small bowel in right inguinal hernia (arrow). (d) CT coronal reformation shows the incarcerated small-bowel loop (arrow) in the right groin. This is the level of the transition point, and all readers were confident of the diagnosis of SBO on both transverse and coronal scans.

View larger version (106K): [in a new window]   Figure 3c: CT scans in a 50-year old man with severe abdominal pain and no fever. (a) Transverse CT scan of upper abdomen obtained with intravenous and oral contrast agents shows multiple dilated loops of proximal small bowel. (b) Transverse CT scan in the pelvis shows decompressed loops (arrow) of distal small bowel. The caliber change indicates an SBO. (c) Transverse CT scan obtained at the level of pubic symphysis shows incarcerated small bowel in right inguinal hernia (arrow). (d) CT coronal reformation shows the incarcerated small-bowel loop (arrow) in the right groin. This is the level of the transition point, and all readers were confident of the diagnosis of SBO on both transverse and coronal scans.

View larger version (147K): [in a new window]   Figure 3d: CT scans in a 50-year old man with severe abdominal pain and no fever. (a) Transverse CT scan of upper abdomen obtained with intravenous and oral contrast agents shows multiple dilated loops of proximal small bowel. (b) Transverse CT scan in the pelvis shows decompressed loops (arrow) of distal small bowel. The caliber change indicates an SBO. (c) Transverse CT scan obtained at the level of pubic symphysis shows incarcerated small bowel in right inguinal hernia (arrow). (d) CT coronal reformation shows the incarcerated small-bowel loop (arrow) in the right groin. This is the level of the transition point, and all readers were confident of the diagnosis of SBO on both transverse and coronal scans.