The imaging features of the “Rigler triad” include SBO, an ectopic gallstone, and pneumobilia because a cholecystenteric fistula is needed for the migration of a large obstructing gallstone to occur ( Fig. On CT a whirl sign may be visualized in which twisting of the sigmoid colon (see Fig. The small bowel has a central location in the abdomen. On plain radiography, dilated colon (dilation being a caliber greater than 6 cm and 9 cm in the cecum) is seen. Definitive diagnosis may require biopsy with immunohistochemical stains. In some instances the diverticulum will extend toward the umbilicus. Abdominal Radiology seeks to meet the professional needs of the abdominal radiologist by publishing clinically pertinent original, review and practice related articles on the gastrointestinal and genitourinary tracts and abdominal interventional and radiologic procedures. When bowel motility is affected by mechanical obstruction or nonobstructive adynamic ileus, gas accumulates within the small bowel. The fistulous tract may also extend circumferentially in the ischiorectal fossa with the tract passing into the contralateral fossa through the posterior rectum, forming a horseshoe fistula. Additional signs and symptoms include fever, rash, nausea, vomiting, headache, malaise, and weight loss. Asymptomatic patients with large hiatal hernias may present with an abnormal lie, that is, organoaxial positioning of the stomach without volvulus. Patients with epiploic appendagitis typically present with an acute onset of abdominal pain with localized tenderness over the portion of the affected colon with the left lower quadrant being the most commonly affected site. Small bowel obstruction is common, accounting for 20% of surgical admissions and 4% of ED visits for abdominal pain. Multiplanar reformations (MPRs) and postprocessing techniques aid in a confident diagnosis and can be helpful to depicting findings. Computed tomography-guided percutaneous abscess drainage is a viable treatment option in patients with abscesses related to diverticulitis in which CT readily depicts the anatomy and may be used to guide catheter placement. Located on the antimesenteric side of the colon, the epiploic or omental appendages are small, lobulated masses containing adipose tissue and blood vessels, arising from the serosal surface of the colon. Gastrointestinal involvement sometimes mimics an acute abdomen or rarely can cause life-threatening hypovolemic shock. Although small bowel follow-through studies can provide spatial resolution in the evaluation of the mucosa that is superior to that of cross-sectional studies, and these studies have been performed in the past to triage patients with suspected SBO into surgical versus nonsurgical management, the widespread use of abdominal CT has largely replaced this practice. There are no clear guidelines when or when not to request an abdominal X-ray (AXR). It is often easiest to identify a transition point by careful inspection of the course of the bowel loops, usually by an antegrade approach starting in the distended proximal loops. Esophagitis can arise from a number of causes, including infection, radiation, gastroesophageal reflux, and medications. On CT the cause can be identified, and imaging appearances vary depending on whether colonic malignancy, acute diverticulitis, volvulus, or other pathologic process is present. 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