If the abdominal pain involves the back, it indicates that the mesentery is being stretched, which is more suggestive of strangulated intestinal obstruction. What tests should be done for periumbilical paroxysmal colic? X-ray abdominal fluoroscopy or radiography is very helpful to confirm the clinical diagnosis and determine the site of intestinal obstruction. In normal people, only a small amount of gas can be seen in the stomach and colon on abdominal radiographs. If there are gas and fluid planes in the small intestine, it indicates that the passage of intestinal contents is obstructed and suggests the presence of intestinal obstruction. Acute small bowel obstruction usually takes hours for sufficient fluid and gas to accumulate in the intestine. The degree of intestinal dilatation after hours of significant fluid plane formation certainly reaches a diagnostic level, and colonic obstruction progresses to the point where radiographic signs appear much longer Inflated small bowel, especially jejunum, can be identified by the circumferential folds across the intestinal canal and can be distinguished from a colon with colonic pouching. In addition, the typical small bowel intestinal pattern is mostly in the central part of the abdomen, while the colonic shadow is in the peri-abdomen or in the pelvis. Depending on the patient’s physical condition, radiographs can be taken from the frontal or lateral position in a standing or horizontal position, and serial radiographs can be taken if necessary. Differential diagnosis of paroxysmal colic around the umbilicus Firstly, the presence of mechanical obstructive factors should be analyzed from the medical history. Dynamic intestinal obstruction includes common paralytic and rare spastic intestinal obstruction; mechanical intestinal obstruction is characterized by paroxysmal colic hyperacusis and asymmetric abdominal distension; while paralytic intestinal obstruction is characterized by absence of colic bowel sounds and uniform distension of the whole abdomen; spastic intestinal obstruction may have sudden onset and disappearance of severe abdominal pain Intermittent irregular bowel sounds are diminished and do not disappear, but there is no abdominal distension. X-ray abdominal plain films can help to distinguish between them: in mechanical obstruction, intestinal distension is limited to the segment of the intestine above the obstruction site; in paralytic obstruction, all the stomach, small intestine and colon are distended to approximately the same extent; in spastic obstruction, the intestine is not obviously distended and dilated. The symptoms and signs of intestinal obstruction are not difficult to diagnose, but the diagnosis is more difficult in the absence of typical manifestations. x-ray abdominal fluoroscopy or radiography is helpful to confirm the clinical diagnosis and determine the site of intestinal obstruction. In normal people, only a small amount of gas can be seen in the stomach and colon on abdominal radiographs. If there are gas and fluid planes in the small intestine, it indicates that the passage of intestinal contents is obstructed and suggests the presence of intestinal obstruction. Acute small bowel obstruction usually takes hours for sufficient fluid and gas to accumulate in the intestine. The degree of intestinal dilatation after hours of significant fluid plane formation certainly reaches a diagnostic level, and colonic obstruction progresses to the point where radiographic signs appear much longer Inflated small bowel, especially jejunum, can be identified by the circumferential folds across the intestinal canal and can be distinguished from a colon with colonic pouching. In addition, the typical small intestine bowel pattern is mostly in the central part of the abdomen, while the colon shadow is in the peri-abdomen or in the pelvis. Depending on the patient’s physical condition, the radiographs can be taken from the frontal or lateral position in a standing or horizontal position, and if necessary, a series of radiographs can be taken.