Bowel obstruction accounts for 2-4% of all presentations of abdominal pain to the Emergency Department(1, 2), and is associated with a 2-8% mortality rate(3). In line with traditional guidance, current Australian guidelines recommend abdominal x-ray (AXR) as the first-line imaging modality for suspected bowel obstruction(4, 5). Advantages of AXR include its speed of acquisition, widespread availability and low radiation dose. However, the diagnostic accuracy of AXR for bowel obstruction is only 50-80%(6). Furthermore, AXR is typically unable to characterise the aetiology of an obstruction or...

We performed a retrospective audit of abdominal imaging orders made by Emergency Department physicians for adult patients with suspected bowel obstruction at the Royal Adelaide Hospital between January 1st 2023 and March 31st 2023. Descriptive analysis was performed to assess the prevalence of use of different imaging modalities. Fisher’s exact tests were used to assess for statistically significant differences in the proportion of individuals who underwent 1) AXR first-line and 2) CT at all between a) individuals aged less than or equal to 71 years...

We included 50 patients. 36% had a history of previous bowel obstruction and 62% had previously undergone abdominal surgery. The number of patients who underwent AXR, CT and US as first-line imaging investigations was 13 (26%), 37 (74%) and 0 (0%) respectively. 92% of patients who underwent AXR first-line subsequently underwent CT. All 30 (100%) patients who required operative management underwent CT beforehand. Previous history of bowel obstruction or abdominal surgery did not significantly impact first-line imaging selection.

Our data demonstrate that imaging with AXR alone rarely yields sufficient diagnostic information to inform management of patients with suspected bowel obstruction in the Emergency Department. Consequently, we recommend Emergency Department physicians employ a low threshold to use abdominal CT as a first-line imaging modality due to its superior diagnostic performance, including ability to identify site, cause and complications of obstruction as well as assist operative planning. Indeed, AXR may be an appropriate first-line imaging modality in a select number of cases- for example, a...

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