When a transition point is not identified, optimized distention of the bowel (through either CT enteroclysis or CT enterography) may be needed to make an intermittent or mild obstruction apparent. CT Enteroclysis CT enteroclysis offers improved sensitivity and specificity over standard CT examinations in evaluating suspected intermittent or low-grade SBO [68,82-84]. The placement of a nasoduodenal tube with active controlled infusion of oral contrast optimizes detection of subtle causes of mild obstructions. There is solid evidence that enteroclysis is highly reliable in revealing sites of low-grade SBO [62,63,85], as well as for distinguishing adhesions from obstructing neoplasms or other etiologies [62]. CT enteroclysis is generally favored over conventional enteroclysis because it avoids the problem of overlapping small-bowel loops; it also has been shown to demonstrate a larger number of bowel abnormalities and more abnormalities outside the bowel [61]. CT enteroclysis should be considered, especially for patients who have a history of malignancy [68]. To our knowledge; however, CT enteroclysis is not widely used in the United States at present because of the practical challenges of nasojejunal intubation and the often-associated issues related to conscious sedation and continuous patient monitoring. Suspected Small-Bowel Obstruction CT Enterography CT enterography does not require intubation of the small-bowel and, therefore, has greater patient acceptance [86]. The increased distention of small-bowel related to the oral contrast ingestion protocol optimizes detection of bowel pathology. To our knowledge; however, its clinical usefulness for diagnosing intermittent or low-grade SBO has not been convincingly established, although one small series showed promise [87].
Suspected Small Bowel Obstruction. When a transition point is not identified, optimized distention of the bowel (through either CT enteroclysis or CT enterography) may be needed to make an intermittent or mild obstruction apparent. CT Enteroclysis CT enteroclysis offers improved sensitivity and specificity over standard CT examinations in evaluating suspected intermittent or low-grade SBO [68,82-84]. The placement of a nasoduodenal tube with active controlled infusion of oral contrast optimizes detection of subtle causes of mild obstructions. There is solid evidence that enteroclysis is highly reliable in revealing sites of low-grade SBO [62,63,85], as well as for distinguishing adhesions from obstructing neoplasms or other etiologies [62]. CT enteroclysis is generally favored over conventional enteroclysis because it avoids the problem of overlapping small-bowel loops; it also has been shown to demonstrate a larger number of bowel abnormalities and more abnormalities outside the bowel [61]. CT enteroclysis should be considered, especially for patients who have a history of malignancy [68]. To our knowledge; however, CT enteroclysis is not widely used in the United States at present because of the practical challenges of nasojejunal intubation and the often-associated issues related to conscious sedation and continuous patient monitoring. Suspected Small-Bowel Obstruction CT Enterography CT enterography does not require intubation of the small-bowel and, therefore, has greater patient acceptance [86]. The increased distention of small-bowel related to the oral contrast ingestion protocol optimizes detection of bowel pathology. To our knowledge; however, its clinical usefulness for diagnosing intermittent or low-grade SBO has not been convincingly established, although one small series showed promise [87].