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Gasless Abdomen in the Adult: What Does It Mean?

¹ Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —38-year-old man with 2 days of mild abdominal pain and no symptoms of bowel obstruction. Note paucity of small-bowel gas on supine (A) and upright (B) abdominal radiographs. Also note small amount of gas in right colon (arrows).

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —38-year-old man with 2 days of mild abdominal pain and no symptoms of bowel obstruction. Note paucity of small-bowel gas on supine (A) and upright (B) abdominal radiographs. Also note small amount of gas in right colon (arrows).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —28-year-old woman with mild abdominal pain. Supine abdominal radiograph shows paucity of gas in small bowel and small amount of gas in right colon and rectum (arrow).

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —17-year-old boy with testicular sarcoma after orchiectomy and retroperitoneal lymph node resection who developed signs and symptoms of small-bowel obstruction. Digital radiograph shows nasoenteric feeding tube in place and small amount of barium present in right colon (arrow) and rectum from prior study. Note lack of gas in small bowel.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —17-year-old boy with testicular sarcoma after orchiectomy and retroperitoneal lymph node resection who developed signs and symptoms of small-bowel obstruction. Axial CT image through lower abdomen shows dilated small bowel completely filled with fluid (arrow). High-grade small-bowel obstruction due to dense adhesions was found at surgery.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —73-year-old woman with history of lymphoma who presented with nausea, vomiting, and sharp pain in left lower abdomen. Supine abdominal radiograph shows paucity of small-bowel gas (large arrow) and small amount of gas and feces in right colon (small arrows).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —73-year-old woman with history of lymphoma who presented with nausea, vomiting, and sharp pain in left lower abdomen. Coronal CT scan shows multiple fluid-filled loops of small bowel extending to pelvis, where transition point was identified (not shown) just distal to feces (arrow) in small bowel ("small-bowel feces sign"). Adhesion found at surgery was responsible for obstruction.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —72-year-old woman with severe abdominal pain and vomiting. Supine abdominal radiograph shows paucity of gas in right side of abdomen with air-containing jejunum that has fold thickening (arrow).

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —72-year-old woman with severe abdominal pain and vomiting. Axial CT scan through mid abdomen shows minimal thickening of air- and fluid-containing dilated small bowel on left side of abdomen (arrows). Note fluid density in central mesentery and tiny amount of ascites in left lower lateral abdomen (arrowhead).

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —72-year-old woman with severe abdominal pain and vomiting. Axial CT scan at level of iliac crests shows dilated fluid-filled small bowel, increased density in central mesentery, and engorged vessels (arrow). At surgery, small-bowel obstruction and ischemic small bowel caused by adhesions were found.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —40-year-old woman with gradual onset of upper abdominal pain. Supine abdominal radiograph shows normal gas in colon and paucity of small-bowel gas.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —40-year-old woman with gradual onset of upper abdominal pain. Upright abdominal radiograph shows normal colonic gas and distended loop of proximal small bowel (arrow) just inferior to stomach and transverse colon.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —40-year-old woman with gradual onset of upper abdominal pain. Radiograph from enteroclysis (tube had been removed) shows abrupt change in caliber of proximal small bowel (arrow) and marked dilation of obstructed proximal small bowel. Distal small bowel is normal. Tiny (1 cm) ulceration at site of obstruction was noted on other radiographs. At surgery, less-than-totally-obstructing 1-cm primary jejunal adenocarcinoma was resected.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —50-year-old man with abdominal pain, nausea, and vomiting. Supine abdominal radiograph shows paucity of gas in lower abdomen and several faintly gas-filled bowel loops in left upper quadrant, some of which are left colon; others could represent dilated fluid-filled small bowel (arrow).

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —50-year-old man with abdominal pain, nausea, and vomiting. Upright abdominal radiograph shows scattered colonic air–fluid levels in periphery of abdomen. Note multiple tiny air–fluid levels in central abdomen that are in small bowel (arrows) and represent dilated fluid-filled loops of small bowel with tiny amounts of gas, the string-of-pearls sign. At surgery, distal small-bowel obstruction caused by adhesion was found.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —73-year-old man with hepatic and renal failure due to amyloid and increasing abdominal distention. Supine abdominal radiograph shows gas-filled stomach and many classic findings of ascites, increased density over abdomen, central location of a few loops of contrast-filled small bowel (arrow), and loss of normal fat outlining posterior liver edge as well as loss of all other normal fat planes.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —73-year-old man with hepatic and renal failure due to amyloid and increasing abdominal distention. Coronal CT image through mid abdomen shows central displacement of small bowel and medial displacement of liver due to ascites.

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —71-year-old woman with known ascites due to liver failure. Supine radiograph of lower abdomen shows perivesical fat (arrows) outlining dome of bladder below and ascites above that extend into perivesical recesses. This finding due to visualization of fluid above perivesical fat has been called "dogears sign."

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —48-year-old woman 6 months after total colectomy for ulcerative colitis who presented for ileostomy removal. Preliminary abdominal radiograph shows paucity of gas throughout abdomen. Note surgical staples in pelvis from J-pouch (arrow).

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —48-year-old woman 6 months after total colectomy for ulcerative colitis who presented for ileostomy removal. Radiograph after instillation of contrast material into J-pouch shows normal distal ileum and contrast material filling ileostomy bag. No extravasation of contrast medium or stricture at ileoanal anastomosis was seen.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —55-year-old man 2 days after esophagogastrectomy for high-grade Barrett's esophagus. Supine abdominal radiograph before barium swallow shows paucity of bowel gas, jejunostomy feeding tube, and cardiac monitoring wires.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —55-year-old man 2 days after esophagogastrectomy for high-grade Barrett's esophagus. Radiograph from barium swallow shows normal postoperative esophagogastrectomy. Note paucity of distal bowel gas.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —28-year-old woman with 2 weeks of mild abdominal pain, nausea, and vomiting. Digital supine abdominal radiograph shows paucity of gas throughout abdomen due to acute enterocolitis.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13A —28-year-old man with known acute myelogenous leukemia who presented with nausea, diarrhea, and fever. Supine abdominal radiograph shows paucity of gas throughout entire abdomen. Tiny amount of gas is present in sigmoid colon (arrow).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13B —28-year-old man with known acute myelogenous leukemia who presented with nausea, diarrhea, and fever. Axial CT images through abdomen show both small- and large-bowel wall thickening (arrows). Small amount of ascites is present in sigmoid mesentery and pelvis (arrowheads, B and C). Note moderate dilation of duodenum and proximal jejunum (arrowhead) due to inflammation in proximal small-bowel mesentery (not shown). After treatment, all findings were shown to have resolved on 2-week follow-up CT. Findings were thought to be caused by neutropenic enterocolitis.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13C —28-year-old man with known acute myelogenous leukemia who presented with nausea, diarrhea, and fever. Axial CT images through abdomen show both small- and large-bowel wall thickening (arrows). Small amount of ascites is present in sigmoid mesentery and pelvis (arrowheads, B and C). Note moderate dilation of duodenum and proximal jejunum (arrowhead) due to inflammation in proximal small-bowel mesentery (not shown). After treatment, all findings were shown to have resolved on 2-week follow-up CT. Findings were thought to be caused by neutropenic enterocolitis.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13D —28-year-old man with known acute myelogenous leukemia who presented with nausea, diarrhea, and fever. Axial CT images through abdomen show both small- and large-bowel wall thickening (arrows). Small amount of ascites is present in sigmoid mesentery and pelvis (arrowheads, B and C). Note moderate dilation of duodenum and proximal jejunum (arrowhead) due to inflammation in proximal small-bowel mesentery (not shown). After treatment, all findings were shown to have resolved on 2-week follow-up CT. Findings were thought to be caused by neutropenic enterocolitis.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13E —28-year-old man with known acute myelogenous leukemia who presented with nausea, diarrhea, and fever. Axial CT images through abdomen show both small- and large-bowel wall thickening (arrows). Small amount of ascites is present in sigmoid mesentery and pelvis (arrowheads, B and C). Note moderate dilation of duodenum and proximal jejunum (arrowhead) due to inflammation in proximal small-bowel mesentery (not shown). After treatment, all findings were shown to have resolved on 2-week follow-up CT. Findings were thought to be caused by neutropenic enterocolitis.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A —54-year-old woman with marked abdominal distention. Supine abdominal radiograph shows marked abdominal fullness, displacement of small bowel cephalad (arrow), and elevation of hemidiaphragm.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B —54-year-old woman with marked abdominal distention. Axial CT scan through mid abdomen shows large multiseptate fluid-filled mass that proved to be metastatic sigmoid colon adenocarcinoma to left ovary.

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