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Suspected Small-Bowel Obstruction

Variant: 1   Suspected small-bowel obstruction. Acute presentation. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
CT abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢
Fluoroscopy small bowel follow-through May Be Appropriate ☢☢☢
Radiography abdomen and pelvis May Be Appropriate (Disagreement) ☢☢☢
MRI abdomen and pelvis without and with IV contrast May Be Appropriate O
MRI abdomen and pelvis without IV contrast May Be Appropriate O
CT abdomen and pelvis without IV contrast May Be Appropriate ☢☢☢
US abdomen and pelvis Usually Not Appropriate O
Fluoroscopy small bowel enteroclysis Usually Not Appropriate ☢☢☢
MR enteroclysis Usually Not Appropriate O
MR enterography Usually Not Appropriate O
CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ☢☢☢☢
CT enteroclysis Usually Not Appropriate ☢☢☢☢
CT enterography Usually Not Appropriate ☢☢☢☢

Variant: 2   Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
Procedure Appropriateness Category Relative Radiation Level
CT abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢
CT enterography Usually Appropriate ☢☢☢☢
Fluoroscopy small bowel enteroclysis May Be Appropriate ☢☢☢
Fluoroscopy small bowel follow-through May Be Appropriate ☢☢☢
MR enteroclysis May Be Appropriate O
MR enterography May Be Appropriate O
MRI abdomen and pelvis without and with IV contrast May Be Appropriate O
MRI abdomen and pelvis without IV contrast May Be Appropriate O
CT abdomen and pelvis without IV contrast May Be Appropriate ☢☢☢
CT enteroclysis May Be Appropriate ☢☢☢☢
US abdomen and pelvis Usually Not Appropriate O
Radiography abdomen and pelvis Usually Not Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ☢☢☢☢

Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Discussion of Procedures by Variant
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
A. CT Abdomen and Pelvis
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
B. CT Enteroclysis
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
C. CT Enterography
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
D. Fluoroscopy Small Bowel Enteroclysis
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
E. Fluoroscopy Small Bowel Follow-Through
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
F. MR Enteroclysis
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
G. MR Enterography
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
H. MRI Abdomen and Pelvis
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
I. Radiography Abdomen and Pelvis
Variant 1: Suspected small-bowel obstruction. Acute presentation. Initial imaging.
J. US Abdomen and Pelvis
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
A. CT Abdomen and Pelvis
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
B. CT Enteroclysis
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
C. CT Enterography
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
D. Fluoroscopy Small-Bowel Enteroclysis
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
E. Fluoroscopy Small-Bowel Follow-Through
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
F. MR Enteroclysis
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
G. MR Enterography
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
H. MRI Abdomen and Pelvis
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
I. Radiography Abdomen and Pelvis
Variant 2: Suspected intermittent or low-grade small-bowel obstruction. Indolent presentation.
J. US Abdomen and Pelvis
Summary of Recommendations
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
Relative Radiation Level Information
References
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Disclaimer

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked.  Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.