Paucity of gas



Keywords: abdominal radiography, gasless abdomen adult, small-bowel obstruction
Description: The cause of the gasless abdomen in small-bowel obstruction is the presence of fluid rather than air filling the lumen of the dilated small bowel proximal to the site of obstruction (Figs. 3A. 3B

The cause of the gasless abdomen in small-bowel obstruction is the presence of fluid rather than air filling the lumen of the dilated small bowel proximal to the site of obstruction (Figs. 3A. 3B and 4A. 4B ). Ischemia can produce similar findings even though thickening of the bowel wall may be present [2. 3 ] (Fig. 5A. 5B. 5C ). A proximal small-bowel obstruction may produce a gasless abdomen (Fig. 6A. 6B. 6C ).

Small-bowel obstruction with or without ischemia is the most serious cause of the gasless abdomen in the adult because it may be life-threatening. The gasless abdomen in the presence of a clinical finding of bowel obstruction implies a more long-standing obstruction, often in the presence of a closed-loop obstruction, strangulation, or ischemic small bowel. Therefore, it is imperative that the radiologist know the patient's history and laboratory data. If symptoms and signs of obstruction or ischemia are present with a gasless abdomen on abdominal radiographs, the referring physician should be contacted immediately. The patient should undergo either emergent confirmatory CT (Figs. 3A. 3B and 4A. 4B ) or a surgical consultation. Some patients will have upright or decubitus radiographs in addition to their nondependent radiographs. These may help confirm the diagnosis of small-bowel obstruction by showing significant air–fluid levels or the string-of-pearls sign (Fig. 7A. 7B ).

CT is the most valuable imaging technique in the evaluation of the gasless abdomen. It can be of great value by confirming not only the presence of a small-bowel obstruction but also the site and cause of the obstruction, as well as showing complications such as closed-loop obstruction and signs of ischemic small bowel (Fig. 5A. 5B. 5C ). This information is critical for the surgeon to manage the patient promptly.

At my institution, we avoid the term “nonspecific abdomen” when a gasless abdomen is encountered. We make every effort to correlate the abdominal radiographic findings with the patient's history so the examination can be interpreted as normal or abnormal.






Photogallery Paucity of gas:


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