ARRS 2022 Abstracts

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E1379. Abnormal Bowel Gas Patterns on Abdominal Radiographs: What do they Signify?
Authors
  1. Sowmiya Murali ; University of New Mexico
  2. Lisa Richardson ; University of New Mexico
  3. Tharani Murali; University of New Mexico
  4. Masoud Shiehmorteza; University of New Mexico
  5. William Thompson ; University of New Mexico
Background
Abdominal pain is one of the more common symptoms encountered in emergency rooms and in-patient services, especially after surgery. In spite of the advances in cross-sectional imaging, abdominal radiographs are still commonly ordered in patients with abdominal pain. For prompt correct care, the radiologist must be familiar with bowel gas abnormalities. In most cases, abdominal plain radiographic abnormalities will be confirmed with CT.

Educational Goals / Teaching Points
After viewing this exhibit, the learner should become familiar with a simple guideline for the correct interpretation of abdominal radiographs with abnormal bowel gas including too much, too little, and in the wrong place.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Abdominal radiographs with supine, upright, and lateral decubitus positioning can help differentiate pathology and anatomy. When too much bowel gas is present within the stomach, differential considerations include gastric outlet obstruction or paresis. Obstruction or ileus in the small or large bowel can also manifest as too much abdominal gas on radiography. When a paucity of bowel gas is present, differential diagnoses include ascites, small bowel obstruction or ischemia, total colectomy, enterocolitis, a large intra-abdominal mass, or it can be normal. Intraluminal gas may represent benign or malignant pneumatosis, although CT has been shown to be more sensitive than radiography at detecting pneumatosis intestinalis.

Conclusion
Abnormal abdominal bowel gas patterns can present in three generalized categories including too much, too little, and in the wrong place. We present a simple guideline to aid radiologists in quickly identifying abnormal bowel gas patterns, contributing to prompt and quality patient care.