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• W2003921183 abstract "While adequate recognition is given to the early radiological investigation of lesions in the stomach, duodenum, and colon, the value of this procedure in small-intestinal obstruction is overlooked. This is due probably to the stress that has been placed upon the former at the expense of the latter. So important is the x-ray in the early diagnosis of intestinal obstruction that emphasis should be placed repeatedly upon its use. In the stomach and colon the gas is more or less free and its distribution is demonstrable as a shadow on the film; in the small bowel the gas is distributed and intimately mixed with the bowel contents and cannot normally be shown by radiologic study. Its demonstration is indicative of bowel interference and is of pathological significance. It presents a shadow early in obstructive lesions of the small bowel which is of great diagnostic value. Although gaseous shadows in the small bowel have been known for over thirty years to be of some importance as an indication of disturbed motility, the profession is still not sufficiently impressed with their diagnostic value to institute an early radiological study in small bowel obstruction. Schwarz, in 1911, called attention to the gaseous shadows seen in the small bowel in obstructive lesions and indicated their significance. He advised the use of an opaque medium as a confirmatory diagnostic agent. In 1914 Case described gas shadows in the small bowel as a diagnostic aid in obstruction. Kloiber, in 1919, was the first to state that the diagnosis of small-bowel obstruction could be made by the gaseous shadows on an x-ray negative, and that a contrast medium was not necessary for confirmation. He demonstrated that gas shadows in the small bowel were abnormal and indicative of obstruction. The typical transverse pattern, described by Case, is not necessary for a diagnosis of small-bowel obstruction. A collection of gas in the small bowel in the adult may be considered as synonymous with obstruction. In very small children, gas may be seen in the small bowel and be of no diagnostic significance. The collection of gas after obstruction is not a late development; it is seen soon after the onset of the obstruction, usually being demonstrable without difficulty in four or five hours. The distribution of the gas in the small intestine is indicative of the probable type of lesion. In simple obstruction, it may be centrally located, with a transverse long axis; in loop obstruction, the dilated loops may assume no definite pattern, and proximal bowel distention is slow in developing. If the walls separating loops are thick, it signifies the presence of fluid or exudate. Collections of gas in the large intestine are quite in contrast to collections in the small bowel, in that the long axis is vertical, the bowel wall is thicker, and haustral markings are present." @default.
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• W2003921183 date "1944-08-01" @default.
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• W2003921183 title "Correlation of the X-Ray Diagnosis with the Operative Findings in Small-Intestinal Obstruction" @default.
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• W2003921183 doi "https://doi.org/10.1148/43.2.107" @default.
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