Which finding is most consistent with nonobstructive ileus on abdominal radiographs?

Which finding is most consistent with nonobstructive ileus on abdominal radiographs?

• A. Free air under the diaphragm
• B. Isolated colonic distention
• C. Air in both small and large bowel with diffuse gaseous distention
• D. Normal gas pattern

Answer: (C)

Nonobstructive ileus shows a generalized slowdown of bowel motility, leading to gas and fluid accumulating throughout the entire bowel tract. On abdominal radiographs this appears as diffuse gaseous distention that involves both the small and large intestines, with gas present all the way through to the colon and rectum and no discrete transition point where a blockage begins. There isn’t a focal point of dilation that would indicate a mechanical obstruction, and the pattern is more uniform rather than localized. This differs from free air under the diaphragm, which would imply perforation; from isolated colonic distention, which suggests a problem limited to the colon or a large-bowel process; and from a normal gas pattern, which would not show diffuse, generalized distention. So seeing air in both small and large bowel with diffuse gaseous distention best fits nonobstructive ileus.

Nonobstructive ileus shows a generalized slowdown of bowel motility, leading to gas and fluid accumulating throughout the entire bowel tract. On abdominal radiographs this appears as diffuse gaseous distention that involves both the small and large intestines, with gas present all the way through to the colon and rectum and no discrete transition point where a blockage begins. There isn’t a focal point of dilation that would indicate a mechanical obstruction, and the pattern is more uniform rather than localized.

This differs from free air under the diaphragm, which would imply perforation; from isolated colonic distention, which suggests a problem limited to the colon or a large-bowel process; and from a normal gas pattern, which would not show diffuse, generalized distention. So seeing air in both small and large bowel with diffuse gaseous distention best fits nonobstructive ileus.