Case of the Month March 2014, page 4

Answer: A. Abdominal and pelvic radiographs are a good first diagnostic imaging test in the setting of small bowel obstruction. In cases of acute abdomen, the presence of free air in a patient without a history of recent abdominal intervention would prompt emergent evaluation by a surgeon and potentially save the time, expense, and radiation dose associated with a CT scan.

You note the patient already had abdominal radiographs showing nonspecific mildly dilated small bowel loops. Still suspecting an obstruction (although perhaps not a high-grade one) and mindful of the ACR appropriateness criteria, what study do you order next?
a) CT abdomen pelvis
b) MR enterography
c) US abdomen
d) No further imaging

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