PMC2716679_01
Abdominal plain radiograph of case 1 on admission showed a markedly dilated small bowel, with no dilatation of the colon.
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Plain abdominal radiograph showed a markedly dilated small bowel, with no dilatation of the colon (Fig. 1).
An abdominal computerized tomography (CT) showed largely distended small bowel loops and a smooth transition zone (arrow) at the site of obstruction.
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An abdominal computerized tomography (CT) showed largely distended small bowel loops and a smooth transition zone (arrow) at the site of obstruction (Fig. 2).
Clinical course of case 1. Changes in breath hydrogen concentration and abdominal plain radiographs on representative dates are demonstrated.
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During the first four days, although small bowel gas increased gradually (Figs. 3A, 3B), breath H2 concentrations remain less than 4 ppm (Fig. 3). On the fifth day after admission, small bowel gas decreased and a small amount of colonic gas was demonstrated on the plain abdominal radiograph (Fig. 3C). Since intestinal gas was gradually reduced on radiographic imaging (Fig. 3D), a liquid meal was supplied at noon on the ninth hospital day. The breath H2 concentration on the next day increased markedly to 19 ppm despite she had no abdominal symptoms and intestinal gas was not increased on the plain abdominal radiograph (Fig. 3E). The patient did not complain of any abdominal symptoms during a routine progressive diet and intestinal gas decreased continuously (Figs. 3F, 3G).
PMC2716679_02
Abdominal plain radiograph of case 2 on admission showed multiple dilated gas-filled small-bowel loops, with no dilatation of the colon one day after undergoing surgical treatment.
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X-ray demonstrated multiple dilated gas-filled small-bowel loops, with no dilatation of the colon (Fig. 4).
Clinical course of case 2 after a treatment with erythromycin. Changes in breath hydrogen concentration and abdominal plain radiographs on representative dates are demonstrated.
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Three days after the beginning of the treatment (Fig. 5A), the plain abdominal radiograph demonstrated a decrease of small-bowel gas and a clear-liquid meal was served after removal of an ileus tube. During those five days, the intestinal gas was unchanged (Figs. 5B, 5C). No abdominal symptom was developed and increased intestinal gas was not found on the plain radiograph (Fig. 5D). Even when a diet order progress to solid foods, the patient did not complain of abdominal symptoms other than flatus and intestinal gas on the plain radiograph was not worsened (Fig. 5E).