International Journal of Anatomy, Radiology and Surgery. 2017 Oct, Vol-6(4): RO45-RO51 45 Original Article ID: 10.7860IJARS/2017/29519:2301 Keywords: Ladd’s band, Obstructed hernia, Recurrent cervical carcinoma, Volvulus ABSTRACT Introduction: Computed Tomography (CT) is a highly sensitive modality with its multi-planar capabilities, used in evaluation of acute cases of intestinal obstruction. It delineates the level and helps to identify various etiologies of obstruction, where plain radiographs can only suggest signs of obstruction. It has an added advantage of detecting further complications, thus framing appropriate surgical approach. Aim: Our study aims at delineating variable CT spectrum of intestinal obstruction with highlight on atypical presentation. Materials and Methods: Retrospective hospital data based study was conducted in the Radiology Department of Shree Krishna Hospital, Anand, Gujarat, India, between 2014-2017 including 40 patients with mechanical causes of obstruction and excluding patients with non-mechanical causes of obstruction. Statistical analysis was done using percentages and proportions using MedCalc software version 17.6. Results: The age range of patients was from 5 days to 83 years and the maximum number of patients i.e., 7 (17.5%) were in the age group of 41-50 years. Radiographic signs related to obstruction like air fluid levels, dilated bowel loops was seen in 26 out of 40 cases (sensitivity 60%). Small bowel obstruction dominated the case list with obstructed hernia as major causative factor. Conclusion: Study highlights the contribution of MDCT in early identification of underlying etiology and complications of obstruction with additional contribution in road mapping and framing appropriate and individualized treatment strategy for patients. Radiology Section Multidetector Computed Tomography (MDCT) in Gastrointestinal Obstruction: One Symptom Myriad Differentials GEETIKA SINDHWANI, VIRAL PATEL, ABHINAV JAIN, MANALI ARORA, PRATIK SHAH INTRODUCTION Abdomen is considered as the “magic box” with endless differential diagnoses for one clinical symptom. Intestinal obstruction is one of the main entities of concern. Manifestations of intestinal obstruction can range from abdominal discomfort and distention to the state of shock requiring an emergency exploration [1]. Bowel obstruction can be mechanical or pseudo-obstruction i.e., paralytic ileus. Mechanical causes of bowel obstruction are myriad and can be divided into mural lesions (like tumour, stricture due to infection, inflammatory bowel disease, congenital causes or irradiation), luminal (bezoar, gall stone, worms or intussusceptions) or due to extrinsic causes (adhesions, hernia, volvulus, abdominal malignancy) [2]. In developed countries, post-surgical adhesions top the list, however, in developing and under developed countries obstructed hernias, infectious disease and mass lesions dominate the cause list [3]. In patients with bowel obstruction, elevated white blood cell counts or serum amylase and lactic acid levels suggest a complication and should prompt investigation and may require surgery [4]. In earlier era, exploratory laparotomy was often performed to solve the mystery of obstruction, but advances in Radiology have led to wiser utilisation of surgical therapies. Dilated gas filled bowel loops are easily identified on the supine radiograph. In significant number of patients with bowel obstruction, abdominal radiograph appears normal or only equivocally abnormal, since the dilated loops are mainly fluid-filled. In such cases, CT aids as a necessary diagnostic tool [2,5]. The plain abdominal radiograph has sensitivity of about 66% for bowel obstruction [5,6]. Barium studies have their limited role mainly in patients with chronic obstruction. Ultrasonography is only of added value in diagnosis of fluid filled bowel loops and demonstrates to and fro movement of bowel contents. However, its role in