KUB

1. What support lines are present? An enteric tube is present projecting in the region of the stomach.

2. What is abnormal? There are many dilated bowel loops winding back and forth through the mid-abdomen, a pattern indicating that the loops are small bowel

3. How acute is the finding likely to be? Given the history, this is likely relatively acute

4. What other history would you like to know about the patient? Most cases of small bowel obstruction are related to prior surgery, so you would like to know this patient's past surgical history, which was appendectomy last year. The obstruction was due to adhesions.

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The best was to identify dilated small bowel loops is to notice the fold pattern. The folds in the small bowel are called either 'plicae' or 'valvulae', and are characteristically close together, evenly spaced, and do not have outpouchings of gas between folds, so the outer margin of the bowel loops is rather smooth. This is in contrast to colon, where the folds (haustra) are unevenly spaced, relatively far apart, and the gas typically protrudes a bit between folds producing an outer margin that is scalloped. Enteric tubes can be recognized on radiographs because they the ones used in the stomach typically have a side hole about 5 cm from the tip (like a chest tube, but smaller caliber).