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Air-fluid levels are often seen in the dilated colon on the upright or decubitus radiographs ( 5 ). The presence of air-fluid levels suggest that the cause of obstruction is more acute since the colonic fluid has not been present long enough to be absorbed.
ICD-9-CM 153.9 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 153.9 should only be used for claims with a date of service on or before September 30, 2015.
Other specified functional intestinal disorders. K59.8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2019 edition of ICD-10-CM K59.8 became effective on October 1, 2018.
2012 ICD-9-CM Diagnosis Code 796.4 : Other abnormal clinical findings Free, official information about 2012 (and also 2013-2015) ICD-9-CM diagnosis code 796.4, including coding notes, detailed descriptions, index cross-references and ICD-10-CM conversion.
Pneumatosis in distended loops of small bowel suggests necrosis. Check to make sure there is no air in the SMV or portal vein. In this example there is stranding in the mesenteric fat within the hernia. This suggests that the hernia is strangulated and at risk of ischemia or necrosis.
The vomiting in SBO tends to be more frequent, in larger volumes, and bilious, which is in contrast to vomiting during an LBO, which typically presents as intermittent and feculent when present. Tenderness to palpation is present in both conditions, but with SBO, it is more focal, and with LBO, it is more diffuse.
In cases where the colon is enlarged, a treatment called decompression may provide relief. Decompression can be done with colonoscopy, a procedure in which a thin tube is inserted into your anus and guided into the colon. Decompression can also be done through surgery.
560.9ICD-9-CM Diagnosis Code 560.9 : Unspecified intestinal obstruction.
X-rays of the abdomen are important in diagnosing the presence of small bowel obstruction. When obstruction occurs, both fluid and gas collect in the intestine. They produce a characteristic pattern called "air-fluid levels". The air rises above the fluid and there is a flat surface at the "air-fluid" interface.
Air-fluid levels are common in normal bowel, but multiple ones (>3 air-fluid levels) usually indicate intestinal obstruction [2]. If an air-fluid level is seen on CT of the peritoneal cavity, then it means gastrointestinal-tract perforation or abscess collections.
Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion. It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right. People suffering from this condition often describe it as "feeling bloated".
Having a distended colon refers to this part of the digestive tract becoming enlarged, sometimes enormously. This increase in size can exert pressure on the walls of the intestine, leading to paralysis of normal digestive movements. When this lack of movement occurs, feces do not move ahead.
Long-tube decompression can aspirate the intestinal contents, decrease edema of the bowel wall[25], enhance bowel motility, and prevent bacterial translocation[26].
ICD-10-CM Code for Other intestinal obstruction K56. 69.
Other intestinal obstruction unspecified as to partial versus complete obstruction. K56. 699 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM K56.
Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction. K56. 609 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
An LBO occurs when there is occlusion of the lumen of the colon anywhere along its course and dilatation of the large bowel proximal to the site of obstruction. Both the clinical findings and the pathophysiology of LBO differ substantially from SBO.
One of the challenges facing radiologists and clinicians is determining the cause of a diffusely dilated colon (≥ 6 cm) on abdominal radiographs. Pseudo-obstruction, dilatation of the colon without mechanical obstruction, can occur as a result of adynamic ileus, ACPO (also known as Ogilvie syndrome), or toxic megacolon. Adynamic ileus can be characterized by diffuse small- and large-bowel dilatation without a transition point. Common causes of adynamic ileus include recent gastrointestinal surgery, recent opiate use, critical illness, neurologic disorders, and metabolic disturbances ( 19 ). ACPO is described as an acute dilatation of the colon due to altered autonomic innervation of the colon. Unlike in an adynamic ileus, perforation may occur with ACPO. Both entities are characterized by colonic dilatation with preserved haustration, smooth inner wall contour, and normal colonic wall thickness. Adynamic ileus is routinely characterized by small-bowel dilatation as well ( 19 ). Colonic distension due to these entities usually occurs with minimal fluid; the presence of air-fluid levels should raise the suspicion of an obstruction ( 19, 20 ). Toxic megacolon, a complication of a variety of infectious, ischemic, and inflammatory diseases of the colon, is characterized by its hallmark feature of marked bowel wall thickening, loss of haustration, and segmental parietal wall thinning ( 11, 21 ).
The more proximal colon volvuli occur due to a congenital defect in the cecum or transverse colon mesentery, which makes these segments of the colon more mobile and prone to twisting ( 40 ). Patients with a large-bowel volvulus causing obstruction present with acute abdominal pain and abdominal distension.
CT is the imaging modality of choice for the diagnosis of the cause of LBO. Multidetector CT is a well-tolerated, rapid imaging examination that allows acquisition of images in one breath hold in the frail without the need for the use of rectal contrast agent or air insufflation. Thin sections and multiplanar reformatting provide accurate delineation of large-bowel morphology. CT can be used to diagnose intraluminal, mural, and extramural causes of LBO. In patients with LBO secondary to malignancy, CT offers the additional benefit of detecting local and regional metastases. CT is also an excellent imaging modality for the detection of inflammation and bowel ischemia. The detection of LBO with CT has been reported to have a sensitivity and specificity of 96% and 93%, respectively ( 3, 23 – 25 ). The diagnosis of LBO is based on dilated large bowel proximal to a transition point and decompressed bowel distal to the obstruction. The presence of a transition point is considered a reliable finding for the diagnosis of LBO ( 3, 24 ).
Toxic megacolon, a complication of a variety of infectious, ischemic, and inflammatory diseases of the colon, is characterized by its hallmark feature of marked bowel wall thickening, loss of haustration, and segmental parietal wall thinning ( 11, 21 ).
Abdominal radiography is usually the first imaging study performed in patients suspected of having LBO ( 4, 5, 14 ). The examination should include supine and nondependent (either upright or left lateral decubitus) radiographs to aid in the diagnosis of LBO and exclude an SBO and to detect pneumoperitoneum.