Answer: CT abdomen pelvis with contrast is usually appropriate in this setting. Abdominal radiograph is less favorable and may be appropriate to evaluate bowel perforation. Least favorable is CT abdomen pelvis with and without contrast. It may be helpful in select cases but should be used with caution because of increased radiation dose. Remember, CT with and without contrast usually means 3 scans (without, with and delayed phase).
You suspect a bowel obstruction. According to the ACR Appropriateness criteria, what is the best first study for this patient?
a) Abdominal and pelvic radiographs
b) CT abdomen and pelvis
c) MR abdomen and pelvis
d) US of the abdomen and pelvis