Although there is little evidence that CT enterography can be used reliably to identify intermittent- or low-grade SBO, the bowel is typically distended to a greater degree than with standard CT and potentially may be of benefit if CT enteroclysis is not performed at an institution. Fluoroscopy Small-Bowel Enteroclysis Methods of examination that challenge the distensibility of the small-bowel, including conventional (ie, fluoroscopic) enteroclysis and CT enteroclysis, offer improved sensitivity and specificity over standard barium small-bowel and CT examinations in evaluating suspected intermittent or low-grade SBO [18,68,82-84,88]. There is solid evidence that enteroclysis is highly reliable in revealing sites of low-grade SBO [62,63], as well as for distinguishing adhesions from obstructing neoplasms or other etiologies [62]. However, enteroclysis has low patient acceptance. Fluoroscopy Small-Bowel Follow-Through Opinions remain divided on the usefulness of SBFT examinations with an orally administered barium contrast. Some investigators have found this examination useful for managing suspected SBO in 68% to 100% of cases [64]. The SBFT could be considered a problem-solving examination following an equivocal CT, particularly with low- grade or intermittent or partial obstruction [65]. Because SBFT is limited by nonuniform small-bowel filling, it cannot test distensibility and has limitations posed by intermittent fluoroscopy; some authorities argue that enteroclysis is the more appropriate imaging examination in problematic SBO cases, especially in low-grade or intermittent obstruction [62,89]. Early reports of possible therapeutic benefits of the use of water-soluble contrast agents in patients with postoperative SBO remain controversial and uncertain [14-16].
Suspected Small Bowel Obstruction. Although there is little evidence that CT enterography can be used reliably to identify intermittent- or low-grade SBO, the bowel is typically distended to a greater degree than with standard CT and potentially may be of benefit if CT enteroclysis is not performed at an institution. Fluoroscopy Small-Bowel Enteroclysis Methods of examination that challenge the distensibility of the small-bowel, including conventional (ie, fluoroscopic) enteroclysis and CT enteroclysis, offer improved sensitivity and specificity over standard barium small-bowel and CT examinations in evaluating suspected intermittent or low-grade SBO [18,68,82-84,88]. There is solid evidence that enteroclysis is highly reliable in revealing sites of low-grade SBO [62,63], as well as for distinguishing adhesions from obstructing neoplasms or other etiologies [62]. However, enteroclysis has low patient acceptance. Fluoroscopy Small-Bowel Follow-Through Opinions remain divided on the usefulness of SBFT examinations with an orally administered barium contrast. Some investigators have found this examination useful for managing suspected SBO in 68% to 100% of cases [64]. The SBFT could be considered a problem-solving examination following an equivocal CT, particularly with low- grade or intermittent or partial obstruction [65]. Because SBFT is limited by nonuniform small-bowel filling, it cannot test distensibility and has limitations posed by intermittent fluoroscopy; some authorities argue that enteroclysis is the more appropriate imaging examination in problematic SBO cases, especially in low-grade or intermittent obstruction [62,89]. Early reports of possible therapeutic benefits of the use of water-soluble contrast agents in patients with postoperative SBO remain controversial and uncertain [14-16].