The patient discussed above was admitted to the hospital and after 24 hours remained distended with no evidence of resolution. Which of the following radiographic studies would be considered appropriate at this time?

a. Contrast enema

b. Enteroclysis study with dilute barium

c. CT scan with dilute barium oral contrast

d. None of the above

Contrast studies such as those listed above may provide specific localization at the point of obstruction and the nature of the underlying lesion. When obstruction of the small intestine is not progressively resolving, a small bowel follow-through is indicated to confirm the presence and location of the obstruction. The history of a previous right hemicolectomy in this patient may also allow reflux through the colon to define the ileocolonic anastomosis and be able to define the site of obstruction in a retrograde fashion. The potential benefits for a CT scan include not only defining the obstruction and perhaps the nature of the lesion, but also in defining any other evidence of abdominal pathology such as metastases, ascites, or parenchymal liver abnormalities which might be present in a patient with a previous neoplasm. Although none of these tests would be contraindicated, failure of this patient to improve will likely mandate an operation and make contrast studies unnecessary. There would appear to be no evidence of strangulation or perforation therefore there are no contraindications to these studies.