What next after a Non Specific Bowel Gas Pattern?

Non specific bowel gas pattern is sometimes used when describing findings on an X-ray of the abdomen by the radiologist. It basically means that the appearance of bowel is unclear on the X-ray and can be normal or abnormal. This doesn’t help the ordering physician much, except to tell him to use his clinical suspicion to guide further workup. X-rays of the abdomen are not very good at ruling in or ruling out bowel obstructions and other abnormalities of bowel.

But, many clinical doctors still order X-rays of the abdomen, or obstructive series as an initial step. They are most helpful when the X-ray is either entirely normal, or grossly abnormal indicating an obstruction. Everything in between is sometimes labeled as non specific.

A normal abdominal X-ray may show scattered gas in non dilated bowel loops, without air fluid levels. A grossly abnormal obstructed bowel will show dilated bowel loops with air fluid levels. Patients with X-rays that show findings between the extremes can also have significant bowel abnormalities including obstruction or ileus. Ileus is where the bowel isn’t working as well or paralyzed.

Therefore, the workup and testing after an abdominal X-ray is strongly dependent on the clinical circumstances. For example, if you have nausea, vomiting, diarrhea and have little kids who are ill, then the abnormal appearance on the X-ray may simply mean you have gastroenteritis.

On the other hand, if your coming in with vomiting and you’ve had abdominal surgery in the past, then bowel obstruction becomes more likely. There are many cases where there is overlap of the clinical symptoms and it’s not clear from either the history or the X-ray.

In these cases, a CT scan will be more definitive. Unlike an X-ray which may not show all the bowel unless it has gas within, the CT shows all the bowel and can indicate whether there is a bowel obstruction, ileus or other emergent condition. The CT will often guide further management, surgical consults and how urgent the condition is.

In many cases, it is best to just go directly to CT and skip the X-ray which is frequently not helpful. Even in those cases where the X-ray is near normal, or grossly abnormal, a CT scan will often follow anyways. So it can be argued that the abdominal X-ray or obstructive series is not necessary in many cases. I’ve seen fewer of these ordered through the emergency room. Many of these X-rays are ordered to follow confirmed bowel obstructions for improvement.

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