Intestinal obstruction is a common surgical emergency abdomen, and “pain, vomiting, distention, and closure” are its typical clinical manifestations, and its X-ray manifestations are roughly described in various books: What does a gas-liquid plane look like? Look at the following typical pictures: 1. Why does intestinal obstruction appear in the liquid plane?
1. first of all, how the gas comes 2. the main source of the liquid Knowing this, together with the basic physics knowledge, it should not be difficult to understand why the gas-liquid plane will be produced when the film is taken in the standing position. Does intestinal obstruction necessarily result in a fluid plane? The answer is, of course, no. There are three elements to the liquid-air plane of intestinal obstruction: fluid, gas, and obstruction.
In the early stage of obstruction, when the bowel function is still relatively normal, gas accumulates in the proximal end of the obstruction and cannot be expelled, and at this time there is more gas and less liquid. Afterwards, gas absorption and exudation increase, and the ratio of liquid to gas is equal, and a typical liquid-gas plane appears; however, as the gas gradually disappears, it becomes mainly liquid accumulation, and the X-ray manifestation can be a string of beads sign or a soccer sign with no gas at all and only liquid accumulation, etc.
The actual course of the disease varies from person to person, and in severe cases, necrosis and exudation are fast, and the performance is dominated by fluid. In contrast, simple intestinal obstruction in general is usually not seen as the football sign because of the typical presentation of immediate surgery. The common adhesive incomplete intestinal obstruction, because the fluid can still be eliminated, the intestinal tube still has peristalsis, the typical performance can last for a relatively long time.
Second, does the presence of fluid level necessarily indicate the presence of intestinal obstruction?
Case sharing: The patient was a male, 20 years old, complaining of metastatic right lower abdominal pain with nausea for one day. The patient complained of no abdominal distension and had bowel movement and exhaustion on the same day. The physical examination and laboratory tests supported acute appendicitis, but not intestinal obstruction. However, X-rays showed the presence of multiple air-fluid flats. Subsequently, surgery was performed and acute appendicitis was confirmed. The explanation for this problem is as follows: it should be normal for 2 to 3 fluid levels to be visible on normal abdominal plain films sometimes, such as the fluid level of the gastric alveoli, the small fluid level of the duodenal bulb, and most importantly, whether the intestinal canal is arching and dilated.
There is another condition where small fluid levels are often seen, such as acute pancreatitis, acute cholecystitis, and acute appendicitis. The explanation is as follows: due to inflammatory stimulation, reflex depression of the surrounding intestinal canal, which is a transient absorption and peristaltic dysfunction of the intestine, small liquid flat and dilation of the intestinal canal can occur, but not intestinal obstruction. Generally, such signs will disappear after symptomatic treatment.