MODERN APPLIED MEDICAL RESEARCH 1(8): 06-09 Corresponding author: Henry Chukwuemeka Okafor ISSN:2582-9181 www.gulfpublishers.com 6 RADIOGRAPHICAL EVALUATION OF INTESTINAL OBSTRUCTION Dr Henry Chukwuemeka Okafor 1 , Ikpeama Osita John 2 , Okafor Jane Nkechinyere 3 , Okafor Rita Ifeyinwa 4 1 Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State 2 Department of Public Health, Imo State University, Owerri; 3 Biochemistry Department, Abia State University, Uturu; 4 Pharmacy Department, Abia State University Teaching Hospital, Aba; Abstract: Intestinal obstruction is a very common case seen all around the world. The diagnosis is very essential to adequate management of such cases. Abdominal radiographs go a long way in making an early and adequate diagnosis of the various types of intestinal obstruction. The most common and cheapest abdominal radiographs needed is the plain abdominal X-Ray, which shows various findings usually in keeping with those seen in other cases of intestinal obstruction. Hence, the importance of abdominal radiographs especially the plain abdominal X-Ray cannot be overemphasized in the proper management of intestinal obstruction. Keywords: Abdominal X-Ray, Intestinal Obstruction, Abdominal Radiography, Abdominal Ultrasonography, Computed Tomography Scan INTRODUCTION: The intestine is a large long tube inside the abdomen. Any obstruction will prevent the passage of faeces and flatus; hence leading to dilation of the part of the intestine just above the level of obstruction. Small bowel obstruction continues to be a substantial cause of morbidity and mortality, accounting for 12-16% of hospital admission for the evaluation of acute abdominal pain in the United States (Nicolaou et al 2005). The management of intestinal obstruction has evolved from immediate surgical repair to initial use of nasogastric tubes for decompression with follow-up abdominal radiography and electrolyte levels. Surgery is now the last option and used in patients who have a significant lesion causing complete obstruction as well as those who fail to respond to nasogastric tube decompression or electrolyte deficit correction and those who also have a complication like strangulation, perforation, ischaemia, or vascular compromise. Most patients suspected of having intestinal obstruction undergo abdominal radiography largely because it is accurate, widely available, and inexpensive (Thompson et al 2007). There are four densities seen on plain abdominal radiographs; white for bone, grey for soft tissue, slightly darker grey for fat and black for air. It shows the abdominal visceral and bowel as well as every other abnormality or foreign object in the abdomen. The diagnosis is improved substantially if radiographs are obtained in both dependent (supine/erect) and non-dependent (upright/decubitus) views (Thompson et al 2007). Technical Consideration A comprehensive diagnostic approach to intestinal obstruction includes clinical history, physical examination, and radiological investigations (Shakil et al 2011). The radiological investigations include abdominal X-Ray, ultrasound, and computed tomography scan. The sensitivity of plain film radiography combined with the clinical background was only 46%, whereas CT had a sensitivity of 100% (Frager et al 1994). Abdominal X-Ray Plain Abdominal Radiography (PAR) is often the initial diagnostic imaging tool for patients with acute abdominal pain (Gans et al 2012). It is still used in many practices as the initial imaging modality for patients experiencing acute abdominal pain due to its low cost and wide availability (Thompson et al 2007). A more recent report showed a sensitivity of only 66% for plain abdominal X-Ray (Shrake et al 1991). In the use of abdominal X-Ray to make a diagnosis of intestinal obstruction, a clear understanding of the normal abdominal X-Ray is important. The small bowel usually lies more centrally, with the large bowel framing it. The upper limits for the normal diameter of different bowel segments are designated by the ‘3/6/9 rule’ as follows: small bowel-3cm, colon-6cm, caecum-9cm. In the acute setting, a plain abdominal X-Ray may consist of a supine and erect abdominal radiograph and an erect chest radiograph. (Mirvis et al 1986). The erect chest view is recommended for diagnosing chest pathologies such as pneumonia, that mimic the symptoms of an acute abdomen (Mayumi et al 2015). The exposure parameters of the chest X- RESEARCH ARTICLE Received: 15-08-2021 Accepted: 22-08-2021 Published: 25-08-2021