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ACUTE ABDOMEN ON
PLAIN RADIOGRAPHS
PRESENTER:
VENNY HILLERY WAHYUNI (I11111021)
CONSULENT:
DR. FENNIE RUFINI, SP. RAD
Epigastrum
Stomach
Pancreas
Mid abdomen
Small intestine
Lower abdomen
Colon, GYN pathology
Clinical Diagnosis
Think Broad Categories for DDx
Inflammation
Obstruction
Ischemia
Perforation (any of above can end here)
Offended organ becomes distended
Supine Abdomen
Erect Abdomen
Perforated viskus
Pneumoperitoneum Necrotizing enterocolitis
with peritonitis Ischemia infarc bowel
Abdominal trauma
Thoracic
Positive pressure ventilation
Pneumomediastinum/pneumotoraks-COPD
Asthma
Abdomen
Pneumoperitoneum Post laparotomy
without peritonitis
Pneumatosis cystoides coli/ intestinalis
Divertikulosis jejunum
Endoscopy
Paracentesis/peritonealdialisis/laparoskopi
Bone marrow transplantation
Erect
Supine
Signs:
Right upper quadrant gas
Riglers (double wall sign)
Urachus
Triangular air
The cupola sign
Football or air dome
LLD
Posisi Lateral dekubitus kiri. Terdapat udara bebas di antara dinding abdomen dengan
hepar (panah putih). Ada cairan bebas di rongga peritoneum (panah hitam).
MASSIVE PNEUMOPERITONEUM
FOOTBALL SIGN Cupola Sign
PNEUMOPERITONEUM
FALCIFORM LIGAMENT SUBHEPATIC GAS BUBBLE
Triangle Sign Triangle Sign
Riglers sign Pneumo-left decubitus
Adynamic Ileus
Stasis of bowel
contents because of
decreased or absent
peristalsis.
The terms adynamic
ileus, paralytic ileus,
and nonobstructive
ileus
Diffuse symmetric,
predominantly gaseous
Distension of bowel
The small bowel, stomach, and
colon are proportionally
dilated without an abrupt
transition.
More bowel loops are dilated
Occasionally, adynamic ileus
may result in A gasless
abdomen with dilated loops of
bowel that are lled only with
uid.
Sentinel Loop
segment of intestine that
becomes paralyzed and
dilated
alerts one to the presence
of an adjacent
inammatory process
short segment of
adynamic Ileus that
appears as an isolated
loop of distended intestine
Toxic Megacolon
extreme dilation of all or a
portion of the colon.
peristalsis is absent and the large
bowel loses all tone and
contractility.
Progressive abdominal distension
and is toxic, febrile, and
obtunded.
The bowel wall becomes like
wet blotting paper, and the risk
of perforation is extreme.
Radiographs
Distension of the colon
with absent haustra.
Dilation of the
transverse Colon up to
15 cm diameter is
often the most striking
nding.
diameter of the colon
Exceeds 5 cm and the
mucosa appears
Mechanical Bowel Obstruction
Stasis of bowel contents above a focal lesion.
The goal of imaging is to conrm the presence of
obstruction, identify its level, and demonstrate its
cause.
The lumen of the bowel proximal to the obstruction
progressively dilates .Compromise of blood supply
may occur
Complete Obstruction, partial Obstruction. Simple
Obstruction, Strangulation obstruction
SMALL BOWEL OBSTRUCTION
Present with crampy
abdominal pain &
distention, vomiting.
Findings :
dilated loops of SB (>3 cm)
small bowel airuid
Supine Erect
Intussusception
Intussusception
Ileocolic, ileoileal, colocolic or jejunojejunal
Soft tissue mass surrounded by crescent of air
Target sign due to peritoneal fat
Barium enema diagnostic (claw sign)
Sausage shaped or target mass on CT
Intussusception