E2280. Imaging the Broken Pipe: Small Bowel Disease as Cause of Abdominal Pain
  1. Laura Machado; Mercy Catholic Medical Center
  2. Elsy Machado; Salford Royal Hospital
  3. Aparna Babu; Mercy Catholic Medical Center
Abdominal pain represents approximately 10% of visits to the Emergency Room and may result from benign to life-threatening conditions. A sizeable portion of these results from small bowel pathology. Imaging studies provide an important role in aiding diagnosis, particularly to differentiate surgical from medical management. Radiologists are required to recognize benign and life-threatening conditions. This educational exhibit is a pictorial review of small pathologies in acute and chronic settings along with a practical approach to facilitate recognition of important findings. Our purpose is to: -Provide a practical approach to diagnosing different small bowel pathologies causing abdominal pain in the acute and chronic setting -Case-based review of common bowel pathology features on radiograph, abdominal CT and MRI -Imaging of complications -Review of management of small bowel pathology including scenarios that involve surgical and Interventional Radiology (IR) management

Educational Goals / Teaching Points
1. Several small bowel pathologies lead to the common pathway of inflammation, micro ischemia, perforation and pneumoperitoneum or abscess formation. As radiologists, we should be able to identify the correct etiology in order to assist our clinicians in patient management. 2. To differentiate surgical from medical cases, we need to assess for obstruction, ischemia, or perforation. Occasionally, inflammatory conditions may need acute surgical intervention. 3. Interventional Radiology has almost replaced surgery in the management of complications related to abscess formation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
- Multimodality imaging of small bowel pathology including infectious and inflammatory bowel disorders, small bowel obstruction, internal hernias, tumors, and intussusception. - Identification of complications including ischemia, perforation, pneumatosis, and abscess formation. An overview of management of these complications. - A pictorial review of CT and MR enterography, which are mainly used to assess chronic complications (fistula, strictures, malignancy, etcetera) of small bowel diseases, particularly inflammatory bowel disorders.

Bowel pathology is a common cause of abdominal pain and therefore, radiologists should become familiar with the imaging appearances, complications and management. During training and early career years, bowel pathology may seem daunting in its complexity. This work will help radiologists familiarize themselves with the manifestations, so that they can be comfortable with wide-ranging appearances on imaging.