1. Small-Bowel Obstruction: State-of-the-Art Imaging and Its Role in Clinical Management 
Dean D.T. Maglinte, Thomas J. Howard, Keith D. Lillemoe, Kumar Sandrasegaran, Douglas K. Rex 
Clinical Gastroenterology and Hepatology 
Volume 6, Issue 2, Pages (February 2008)
DOI: /j.cgh
Copyright © 2008 AGA Institute Terms and Conditions

2. Figure 1
CT diagnosis of strangulation. Transverse CT image of a middle-aged patient who presented with severe acute abdominal pain shows a long distended small-bowel loop containing small-bowel folds (arrow) diagnostic of intussusception (bowel within bowel). Ascitic fluid with increased attenuation (arrowheads) compared with water is seen, which is suggestive of hemorrhage. There are patchy segments of decreased mucosal enhancement (curved arrow) indicating diminished perfusion. The diagnosis of a strangulated small-bowel intussusception without a lead point was confirmed at surgery.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

3. Figure 2
Abdominal/CT versus CT enteroclysis in the diagnosis of low-grade SBO. (A) Abdominal CT transverse image shows no evidence of distended small bowel and was interpreted as showing no evidence of mechanical SBO. This was the third unremarkable abdominal CT in 15 months in this 38-year-old man presenting with recurrent abdominal pain after remote appendicectomy. A small-bowel follow-through also was reported as normal. (B) Transverse image of CT enteroclysis with positive enteral contrast, performed 3 days after the last abdominal CT, shows distended proximal bowel loop with abrupt tapering of caliber (arrowhead) adjacent to the anterior parietal peritoneum. The distal small bowel contains enteral contrast but is nondistended (arrow), indicating a significant gradient (ie, obstruction). Low-grade obstruction secondary to anterior enteroparietal peritoneal and enteroenteric (interloop) adhesions were diagnosed and proved on subsequent laparoscopic adhesiolysis. Enteral infusion challenges the distensibility of the bowel wall and exaggerates prestenotic dilation of partial obstruction and facilitates demonstration of small intraluminal or mural masses. Its negative predictive value is high compared with other imaging methods, which is important in an organ with a low incidence of disease whose symptoms are nonspecific.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

4. Figure 3
Differentiation of active inflammatory stenotic and fibrostenotic phenotypes of Crohn’s disease with partial mechanical SBO using CT enteroclysis with neutral enteral with intravenous contrast. (A) Coronal reformation of neutral enteral contrast CT enteroclysis in a 59-year-old woman shows mucosal hyperenhancement (black arrow), thickened wall (asterisk), luminal narrowing of terminal ileum, and prominent vasa recta (black arrowhead), the comb sign. Proximal small bowel was distended (white arrow). Findings indicate active inflammatory subtype of Crohn’s disease with secondary obstruction. Note mild, irregular bile duct dilation (white arrowheads) indicating associated sclerosing cholangitis. The patient was treated with immunomodulatory therapy. (B) A 49-year-old woman with Crohn’s disease presented with chronic abdominal pain and vomiting. Coronal reformation of CT enteroclysis showed stricture of terminal ileum (arrowhead). The thickened small bowel wall did not significantly enhance and there was no engorgement of the vasa recta. Mild mucosal hyperenhancement may be seen in patients with fibrostenosis. Colonoscopic dilation was performed. Biopsy specimens did not show active inflammation. The use of intravenous contrast allows accurate characterization of Crohn’s disease phenotypes and adjacent soft-tissue abnormalities. Neutral enteral contrast, however, cannot be used in patients with a history of vomiting because infusion cannot be monitored by fluoroscopy compared with positive enteral contrast because it is not visible fluoroscopically and is infused blindly at a high rate to distend bowel.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

5. Figure 4
Imaging of SBO from partially obstructing masses. An 80-year-old man with a history of colon cancer presented with nausea and vomiting. (A) Conventional CT with oral and intravenous contrast shows distended small-bowel loops (arrow), but no bowel mass or etiology of dilatation seen. (B) Positive enteral contrast CT enteroclysis performed 2 weeks later shows multiple masses in small-bowel wall (arrowheads) consistent with serosal metastases with secondary multiple points of obstruction (arrow). Metastases were proven to be the cause of bowel obstruction at surgery.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions

6. Figure 5
Maglinte long tube. (A) Image of Maglinte long tube with stiffening wire that helps maneuver the tube into the proximal jejunum. The adapter (in the middle of the circle formed by the guidewire) facilitates its connection to wall suction. The straight and curved ends of the guidewire allow directional change during fluoroscopic advancement. (B) Line diagram of the tube. b = balloon port, d = drainage port, s = sump port (helps prevent the tube from becoming obstructed by debris). The inset figures show the cross-sectional appearances of the tube at positions a and b. The tube is 13.5F and is better tolerated than the smallest nasogastric tube.
Clinical Gastroenterology and Hepatology 2008 6, DOI: ( /j.cgh )
Copyright © 2008 AGA Institute Terms and Conditions