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EMC /P <>BDC BT /TT2 1 Tf 11 0 0 11 61.6929 505.9913 Tm 0 0 0 0 k .01 Tc .1061 Tw (Radiology is important at all stages of the management of intestinal failure \(IF\), starting from)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0297 505.9913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 540.3633 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 544.6967 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 549.0303 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 553.3638 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 557.6973 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 562.0309 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 566.3644 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 570.6978 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 575.0315 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 579.365 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 583.6985 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 588.032 505.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 489.9913 Tm .0127 Tw (the initial diagnosis \(e.g. ischaemia, perforation, obstruction and sepsis\), to detecting and treating)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0288 489.9913 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 539.2245 489.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 542.4201 489.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 545.6158 489.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 548.8115 489.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 552.0072 489.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 555.2029 489.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 473.9913 Tm .01 Tc .0725 Tw (complications \(e.g. sepsis and its drainage\), inserting parenteral or enteral feeding tubes, and)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0295 473.9913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 539.9928 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 543.956 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 547.9191 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 551.8823 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 555.8456 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 559.8088 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 563.7719 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 567.7352 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 571.6985 473.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 457.9913 Tm .01 Tc .1384 Tw (the planning of reconstructive surgery \(mapping the in and out of circuit bowel, fistula tracts)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0295 457.9913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 540.7186 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 545.4075 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 550.0965 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 554.7854 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 559.4744 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 564.1633 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 568.8524 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 573.5413 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 578.2303 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 582.9192 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 587.6082 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 592.2971 457.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 441.9913 Tm .0027 Tc .0668 Tw [(and the abdominal wall\). )18.1(These tips highlight what radiology can of)18.1(fer with regards to diagnosis)]TJ ET EMC /P <>BDC BT 11 0 0 11 536.0295 441.9913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 539.8497 441.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 543.6699 441.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 547.4901 441.9913 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 425.9913 Tm (and therapeutic options \(excluding access for nutritional support and radio-isotopic tests\).)Tj ET EMC /P <>BDC BT 11 0 0 11 495.8223 425.9913 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 12 0 0 12 38.9931 386.1936 Tm 1 .89 0 0 k (Key points)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 100.3349 386.1936 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 368.9743 Tm (1.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 368.9743 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 368.9743 Tm (The radiologist is a key member of the IF multidisciplinary team )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 357.4244 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 357.4244 Tm (\(MDT\) and helps with both diagnostic and therapeutic procedures. )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 345.8745 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 345.8745 Tm (Radiological tests should be discussed with the radiologist before )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 334.3244 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 334.3244 Tm (they are requested.)Tj ET EMC /P <>BDC BT 8 0 0 8 119.2653 334.3244 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 317.105 Tm (2.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 317.105 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 317.105 Tm (The choice of radiological technique depends upon the availability )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 305.555 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 305.555 Tm (of equipment, the expertise of the local radiology department, and )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 294.005 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 294.005 Tm -.005 Tc (whether the patient is acutely unwell or stable with chronic problems. )Tj ET EMC /P <>BDC BT 8 0 0 8 292.9503 294.005 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 276.7857 Tm -.005 Tc (3.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.149 276.7857 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 276.7857 Tm -.005 Tc [(A)55.2( plain abdominal radiograph \(AXR\) may be appropriate in the acute)]TJ ET EMC /P <>BDC BT 8 0 0 8 290.0603 276.7857 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 265.2358 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 265.2358 Tm (setting to diagnose obstruction, ileus, perforation and the extent/ )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 253.6857 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 253.6857 Tm (severity of inflammatory bowel disease \(IBD\), and can be helpful )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 242.1357 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 242.1357 Tm (in monitoring the progress of acute colitis.)Tj ET EMC /P <>BDC BT 8 0 0 8 197.9606 242.1357 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 224.9164 Tm (4.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 224.9164 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 224.9164 Tm (Computerised tomography \(CT\) \(with intravenous and oral contrast )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 213.3664 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 213.3664 Tm (when possible\) is usually the best test in an acute setting, as it is )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 201.8164 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 201.8164 Tm (readily accessible in most acute hospitals and is quick to perform. )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 190.2664 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 190.2664 Tm [(In both acute and elective settings, CT)18.1( can provide an accurate )]TJ ET EMC /P <>BDC BT 8 0 0 8 48.109 178.7164 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 178.7164 Tm (diagnosis and allows an extra-intestinal assessment including the )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 167.1664 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 167.1664 Tm (state of the abdominal wall. )Tj ET EMC /P <>BDC BT 8 0 0 8 151.7223 167.1664 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 149.9471 Tm (5.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 149.9471 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 149.9471 Tm (Magnetic resonance enterography \(MRE\) can produce high quality )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 138.3971 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 138.3971 Tm -.025 Tc (images of the small bowel \(SB\), but it can be challenging to consistently )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 126.8471 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 126.8471 Tm -.01 Tc (obtain optimal quality images in all patients. Patient movement, bowel)Tj ET EMC /P <>BDC BT 8 0 0 8 291.0902 126.8471 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 115.2971 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 115.2971 Tm (peristalsis or inability to maintain a breath hold can result )Tj ET EMC /P <>BDC BT 8 0 0 8 254.9931 115.2971 Tm (in sub- )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 103.7471 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 103.7471 Tm -.01 Tc (optimal non-diagnostic images, so careful patient selection is needed. )Tj ET EMC /P <>BDC BT 8 0 0 8 293.2446 103.7471 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 86.5278 Tm (6.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 86.5278 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 86.5278 Tm (Ultrasound \(US\) is user dependent, but with appropriate expertise, )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 74.9778 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 74.9778 Tm (US scans can provide greater resolution and information than is )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 63.4278 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 63.4278 Tm (possible with other imaging modalities, particularly in thin patients or)Tj ET EMC /P <>BDC BT 8 0 0 8 291.3395 63.4278 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 51.8778 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 51.8778 Tm -.01 Tc (when the probe can be placed close to the structure being evaluated. )Tj ET EMC /P <>BDC BT 8 0 0 8 291.6467 51.8778 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 296.092 51.8778 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 389.1057 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 368.4365 Tm (7.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 368.4365 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 368.4365 Tm [(A)55.2( barium follow through \(BFT\) alone, or in combination with a CT)18.1( )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 356.4364 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 356.4364 Tm (scan, will usually give the information required \(length and quality )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 344.4364 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 344.4364 Tm [(of bowel\) for mapping bowel before reconstructive surgery)74.2(. )]TJ ET EMC /P <>BDC BT 8 0 0 8 525.2533 344.4364 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 326.7672 Tm (8.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 326.7672 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 326.7672 Tm (Contrast fluoroscopy \(with bowel distension\) is useful for the )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 314.7672 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 314.7672 Tm [(determination of patency)74.2(, length and quality of out of circuit bowel )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 302.7672 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 302.7672 Tm [(prior to distal feeding or reconstructive surgery)74.2(. )]TJ ET EMC /P <>BDC BT 8 0 0 8 483.8939 302.7672 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 285.0979 Tm (9.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 285.0979 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 285.0979 Tm [(Intra-abdominal sepsis is usually detectable by CT)110.8(, but a multi-)]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 273.0979 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 273.0979 Tm (modality approach may be needed. Drainage can be achieved )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 261.0979 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 261.0979 Tm [(by CT)18.1( or US guidance, depending upon which provides the best )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 249.0979 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 249.0979 Tm (accessibility or visibility of the collection. )Tj ET EMC /P <>BDC BT 8 0 0 8 459.5775 249.0979 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 231.4286 Tm -.09 Tc (10.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 231.4286 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 231.4286 Tm (Diagnosis of small bowel obstruction \(SBO\) or ischaemia can be )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 219.4286 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 219.4286 Tm (challenging. If there is a strong clinical suspicion of either condition )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 207.4286 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 207.4286 Tm (and the initial radiology report doesnt match the clinical concern, )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 195.4286 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 195.4286 Tm (urgent review by a specialist gastro-intestinal \(GI\) radiologist )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 183.4286 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 183.4286 Tm (maximises the chance of making a correct diagnosis.)Tj ET EMC /P <>BDC BT 8 0 0 8 503.1635 183.4286 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 165.7593 Tm -.1642 Tc [(11)-74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 165.7593 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 165.7593 Tm (The best technique for mapping a fistula tract is dependent on its )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 153.7593 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 153.7593 Tm [(location, accessibility and complexity)74.2(, and upon the general state )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 141.7593 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 141.7593 Tm [(of the patient. )55.2(A)55.2( CT)18.1( and/or BFT)18.1( can provide an accurate overview )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 129.7593 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 129.7593 Tm (for SB mapping, with fluoroscopy \(fistulogram\) adding more )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 117.7593 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 117.7593 Tm (detail. )Tj ET EMC /P <>BDC BT 8 0 0 8 339.0931 117.7593 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 100.09 Tm -.09 Tc (12.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 100.09 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 100.09 Tm (Review by a GI radiologist of all current and previous imaging,)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 88.09 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 88.09 Tm (including those obtained in other institutions, may provide the )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 76.09 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 76.09 Tm (required understanding of complex bowel anatomy not discernible )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 64.09 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 64.09 Tm [(on a single examination or modality)74.2(, and can guide further )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 52.09 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 52.09 Tm (imaging. )Tj ET EMC /P <>BDC BT 8 0 0 8 347.9839 55.09 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 9 0 0 9 22.6772 814.1643 Tm 1 .15 0 0 k [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.78 595.29 1.417 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3571 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2006 14.3571 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 38.993 546.5861 Tm 0 0 0 .8 k [(Arun Gupta and the BIF)55.2(A)55.2( Committee)]TJ ET EMC /P <>BDC BT 7 0 0 7 495.7835 15.0865 Tm 0 0 0 0 k (May 2024 | Page 1 of 3)Tj ET EMC Q endstream endobj 65 0 obj <>/ExtGState<>>> endobj 71 0 obj <> endobj 111 0 obj <>stream /Figure <>BDC q 1 i -16 794.836 625.344 -936.03 re 297.645 420.96 m W* n 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS2 gs q 702.114 106.142 -80.977 535.654 11.868 -89.181 cm /Im1 Do Q EMC /P <>BDC Q q 1 i 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS1 gs BT /TT4 1 Tf 9 0 0 9 22.6772 814.1656 Tm 1 .15 0 0 k 0 Tc 0 Tw [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.781 595.29 1.4171 re f EMC /Artifact <>BDC 1 .1 0 .1 k .015015 0 595.29 31.482 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3583 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2007 14.3583 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /P <>BDC BT /TT2 1 Tf 7 0 0 7 495.2301 15.0863 Tm (May 2024 | Page 2 of 3)Tj ET EMC /P <>BDC BT /TT4 1 Tf 12 0 0 12 36.8503 780.1547 Tm 1 .89 0 0 k (Explanations)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 111.5339 780.1547 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8503 762.6854 Tm (1.)Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 45.9663 762.6854 Tm ( )Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 48.189 762.6854 Tm [(The radiologists are key members of the MDT)18.1( caring for patients )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 750.8854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 750.8854 Tm [(with IF)110.8(. )18.1(They are critical to defining the initial diagnosis \(e.g. of )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 739.0854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 739.0854 Tm (perforations, sepsis, ischaemia and obstruction/)Tj ET EMC /P <>BDC BT 8 0 0 8 217.1655 739.0854 Tm -.01 Tc (ileus\) and reducing )Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 727.2854 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 727.2854 Tm -.01 Tc (the risk of misdiagnosis. SBO,)Tj ET EMC /P <>BDC BT 8 0 0 8 152.4973 727.2854 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 154.72 727.2854 Tm -.005 Tc (for instance, can )Tj ET EMC /P <>BDC BT 8 0 0 8 214.9222 727.2854 Tm 0 Tc (easily be mistaken )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 715.4854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 715.4854 Tm [(for ileus and, similarly)74.2(, reversible bowel ischaemia can be missed )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 703.6854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 703.6854 Tm (as signs can be non-specific. Radiologists perform key therapeutic )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 691.8854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 691.8854 Tm (procedures, including draining sepsis, inserting stents to relieve )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 680.0854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 680.0854 Tm (bowel obstruction as an alternative to surgery or for vascular )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 668.2854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 668.2854 Tm [(strictures to enhance blood supply)74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 171.2241 668.2854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8503 650.8161 Tm -.01 Tc (2.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 650.8161 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 650.8161 Tm (Choosing the best radiological modality is a highly individualised )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 639.0161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 639.0161 Tm (decision dependant on the patient and clinical context. In complex )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 627.2161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 627.2161 Tm (cases, it is preferable to seek the advice of the radiologist as soon )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 615.4161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 615.4161 Tm -.01 Tc (as possible, to help determine the best test to utilise in each situation.)Tj ET EMC /P <>BDC BT 8 0 0 8 288.1941 615.4161 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 603.6161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 603.6161 Tm (They can best make that decision when provided with all relevant )Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 591.8161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 591.8161 Tm [(clinical and surgical history)74.2(, allowing them to consider the patient)18.1(s )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 580.0161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 580.0161 Tm (clinical state, local radiological expertise and availability of each )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 568.2161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 568.2161 Tm [(modality in the time frame required. )18.1(The importance of providing a )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 556.4161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 556.4161 Tm (comprehensive and accurate clinical history to allow the correct )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 544.6161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 544.6161 Tm (choice of radiology techniques, cannot be overstated.)Tj ET EMC /P <>BDC BT 8 0 0 8 237.2007 544.6161 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8503 527.1468 Tm (3.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 527.1468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 527.1468 Tm [(An )55.2(AXR is one of the oldest imaging tests, and its persistence, )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 515.3468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 515.3468 Tm (despite the many advances in medical imaging, is testament to )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 503.5468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 503.5468 Tm [(its extensive utility)74.2(. Globally)74.2(, it)18.1(s most common role lies in the )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 491.7468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 491.7468 Tm [(assessment of the acutely unwell patient, particularly if CT)18.1( scanning)]TJ ET EMC /P <>BDC BT 8 0 0 8 288.1616 491.7468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 479.9468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 479.9468 Tm [(is not readily available. )55.2(Advantages include ease of access \(such )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 468.1468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 468.1468 Tm (as the potential for portable films for the unstable patient\) and a )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 456.3468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 456.3468 Tm (relatively low radiation dose \(usually <0.5 mSV\). Plain films can )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 444.5468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 444.5468 Tm (often be more readily interpreted by non-radiologists than other )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 432.7467 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 432.7467 Tm (modalities, allowing rapid identification or exclusion of major )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 420.9468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 420.9468 Tm [(pathology)74.2(. )55.2(AXR following water-soluble contrast \(e.g. oral )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 409.1468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 409.1468 Tm (Gastrografin)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 92.2085 411.4717 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 95.7452 409.1468 Tm (\) can be used in prognostication of acute SBO, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 397.3467 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 397.3467 Tm [(helping to predict which patients can be managed conservatively)74.2(. )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 385.5467 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 385.5467 Tm (Often 100 ml of contrast is diluted with an equal volume of water )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 373.7467 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 373.7467 Tm (with films taken at 4 and if necessary 24 hours post-ingestion. )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 361.9468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 361.9468 Tm [(An )55.2(AXR may also demonstrate other bowel pathologies, such as )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 350.1468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 350.1468 Tm [(colitis \(for which it remains a time and cost-ef)18.1(ficient test\) and )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 338.3467 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 338.3467 Tm (perforation and can be used in the diagnosis of SB ileus \(either )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 326.5467 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 326.5467 Tm (post-operative or related to other systemic processes\).)Tj ET EMC /P <>BDC BT 8 0 0 8 241.1616 326.5467 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8503 309.0774 Tm (4.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 309.0774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 309.0774 Tm [(Most types of CT)18.1( scans are quick to acquire and readily available )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 297.2774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 297.2774 Tm [(in acute hospitals, but as CT)18.1( enterography \(CTE\) requires the )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 285.4775 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 285.4775 Tm -.005 Tc (patient to drink up to 1 litre of oral contrast, it may not be appropriate)Tj ET EMC /P <>BDC BT 8 0 0 8 287.5861 285.4775 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 273.6774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 273.6774 Tm (in the acute presentation. In most non-urgent settings CTE should )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 261.8774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 261.8774 Tm (be considered in patients who may not be able to hold their breath )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 250.0774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 250.0774 Tm [(as required for MRE, as CT)18.1( is less susceptible to breathing/motion )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 238.2774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 238.2774 Tm [(artefact. In addition, CT)110.8(s can be easier to interpret when compared )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 226.4774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 226.4774 Tm [(to US or MRE. )55.2(A)55.2( CT)18.1( scan also allows a thorough extra-intestinal )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 214.6774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 214.6774 Tm (assessment and is sensitive for detecting deep seated collections. )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 202.8774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 202.8774 Tm [(CT)18.1( is often preferable in larger patients, whereas US may be more )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 191.0774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 191.0774 Tm [(appropriate in thin patients. However)55.2(, CT)18.1( has a significant radiation )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 179.2773 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 179.2773 Tm (dose \(typically between 10-20 mSV\), so it is essential to discuss )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 167.4774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 167.4774 Tm (cases with the radiologist to ensure the most appropriate protocol is )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 155.6774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 155.6774 Tm -.015 Tc (utilised, that will maximise the information obtained from a single scan.)Tj ET EMC /P <>BDC BT 8 0 0 8 288.8784 155.6774 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 291.1012 155.6774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8503 138.2081 Tm (5.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 138.2081 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 138.2081 Tm (MRE scanning can potentially provide much of the required )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 126.4081 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 126.4081 Tm (information when electively evaluating the SB, but careful )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 114.6081 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 114.6081 Tm (patient selection is crucial as any problems \(e.g. claustrophobia, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 102.808 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 102.808 Tm [(dif)18.1(ficulty breath-holding or lying still for the time required\) can result)]TJ ET EMC /P <>BDC BT 8 0 0 8 288.8503 102.808 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 91.0081 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 91.0081 Tm (in )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 91.0081 Tm [(sub-optimal or even non-diagnostic images. Unfortunately)74.2(, )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 79.2079 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 79.2079 Tm (much of the literature fails to highlight these practical challenges, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 67.4081 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 67.4081 Tm (sometimes )Tj ET EMC /P <>BDC BT 8 0 0 8 89.0874 67.4081 Tm -.01 Tc (leading clinicians and patients to inappropriately choose)Tj ET EMC /P <>BDC BT 8 0 0 8 45.3543 55.6082 Tm ( MR scanning)Tj ET EMC /P <>BDC BT 8 0 0 8 93.305 55.6082 Tm 0 Tc ( when other techniques may be preferable. )Tj ET EMC /P <>BDC BT 8 0 0 8 247.1761 55.6082 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 783.0668 Tm (6.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 783.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 783.0668 Tm (Ultrasound is very user dependent, but with appropriate expertise )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 771.3368 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 771.3368 Tm (and patient selection, can provide a more detailed assessment of )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 759.6068 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 759.6068 Tm (the bowel than CTE or MRE. US can be challenging in patients )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 747.8768 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 747.8768 Tm (with stoma bags or other abdominal wall coverings, which may limit )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 736.1469 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 736.1469 Tm (the )Tj ET EMC /P <>BDC BT 8 0 0 8 327.5416 736.1469 Tm (access for an US probe to allow an adequate assessment. )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 724.4169 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 724.4169 Tm (Considering these factors, early discussion with radiologists can )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 712.6869 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 712.6869 Tm (highlight patients in whom US is the best test. )Tj ET EMC /P <>BDC BT 8 0 0 8 482.0298 712.6869 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 695.2876 Tm (7.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 695.2876 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 695.2876 Tm [(Although BFT)18.1( is less frequently utilised than CTE or MRE in many )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 683.5576 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 683.5576 Tm -.01 Tc (UK centres, it still has a significant role in SB assessment, particularly)Tj ET EMC /P <>BDC BT 8 0 0 8 553.7719 683.5576 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 671.8276 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 671.8276 Tm -.005 Tc (in SB mapping. It is best performed after a period of fasting \(between)Tj ET EMC /P <>BDC BT 8 0 0 8 554.7026 671.8276 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 660.0976 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 660.0976 Tm [(4-12 hours\), to ensure the small intestine is empty)74.2(. BFT)18.1( involves )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 648.3676 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 648.3676 Tm (oral ingestion of barium suspension \(typically 300-600 ml of 50% )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 636.6376 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 636.6376 Tm (w/v BaSO4\). Ideally the barium is followed from DJ flexure to the )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 624.9076 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 624.9076 Tm (terminal ileum, using intermittent fluoroscopic imaging, initially every)Tj ET EMC /P <>BDC BT 8 0 0 8 553.9113 624.9076 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 613.1776 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 613.1776 Tm (15 minutes, whilst the barium is progressing. Some centres limit )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 601.4476 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 601.4476 Tm (fluoroscopic assessment to the terminal ileum for simple cases. )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 589.7176 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 589.7176 Tm (Insertion of a trans-nasal catheter into the SB, to perform )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 577.9876 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 577.9876 Tm (a SB enema/enteroclysis is now only used in a few centres )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 566.2576 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 566.2576 Tm (or selected patients, as this test can be unpleasant for the patient. )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 554.5276 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 554.5276 Tm (Barium is not used if there is a risk of it leaking into the peritoneal )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 542.7976 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 542.7976 Tm (cavity as it can precipitate peritonitis. Nonetheless, the examination )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 531.0676 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 531.0676 Tm (still has significant utility and can provide a greater assessment of )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 519.3376 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 519.3376 Tm [(mucosa, fold pattern and motility)74.2(, that is not easily appreciable with )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 507.6076 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 507.6076 Tm (other tests. )Tj ET EMC /P <>BDC BT 8 0 0 8 374.0298 507.6076 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 490.2083 Tm (8.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 490.2083 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 490.2083 Tm (Fluoroscopy \(contrast studies including BFT\) have the distinct )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 478.4784 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 478.4784 Tm (advantage of allowing the operator to provide functional assessment)Tj ET EMC /P <>BDC BT 8 0 0 8 554.8527 478.4784 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 466.7484 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 466.7484 Tm [(by acquiring dynamic \(cine\) images. )55.2(Amongst other information, )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 455.0183 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 455.0183 Tm [(it provides the opportunity to assess SB motility)74.2(. Fluoroscopy )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 443.2884 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 443.2884 Tm (studies utilise either barium based or iodinated \(water-soluble\) )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 431.5584 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 431.5584 Tm (contrast. Barium is generally preferred when opacifying the GI tract, )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 419.8284 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 419.8284 Tm (as it provides more detail and does not become so diluted in the )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 408.0984 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 408.0984 Tm [(distal bowel, which can minimise the interpretation dif)18.1(ficulties due )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 396.3684 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 396.3684 Tm (to overlapping bowel segments. )Tj ET EMC /P <>BDC BT 8 0 0 8 428.1027 396.3684 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 378.9691 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 378.9691 Tm (In addition, the greater density and other properties of barium may )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 367.2391 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 367.2391 Tm (increase the sensitivity in identifying a fistula. Barium should be )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 355.5091 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 355.5091 Tm (avoided where acute, non-mature enteric fistulae are suspected, )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 343.7791 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 343.7791 Tm [(and should not be given within 3 months of acute fistulation. W)37.1(ater )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 332.0491 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 332.0491 Tm (soluble contrast may be useful in these circumstances and when )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 320.3191 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 320.3191 Tm (there is a risk of acute perforation or if surgery may be performed )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 308.5891 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 308.5891 Tm -.02 Tc [(soon after the study)74.2(. W)37.1(ater soluble contrast can safely be administered)]TJ ET EMC /P <>BDC BT 8 0 0 8 552.8071 308.5891 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 296.8591 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 296.8591 Tm (via any route, including vascular or where there is risk of entering )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 285.1292 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 285.1292 Tm [(the peritoneal cavity)74.2(, whereas barium is only safe to administer into )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 273.399 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 273.399 Tm (the lumen of the GI tract. Fluoroscopy is used to assess in and out )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 261.6691 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 261.6691 Tm (of circuit bowel in addition to fistulas. In thin patients, defunctioned )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 249.9391 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 249.9391 Tm -.01 Tc [(bowel is often hard to assess on CT)18.1( or MRI, so fluoroscopy combined)]TJ ET EMC /P <>BDC BT 8 0 0 8 554.2026 249.9391 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 238.2091 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 238.2091 Tm (with contrast distension and a dynamic assessment, can improve )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 226.4792 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 226.4792 Tm (detection of strictures or adhesions.)Tj ET EMC /P <>BDC BT 8 0 0 8 439.6573 226.4792 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 209.0799 Tm (9.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 209.0799 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 209.0799 Tm (Internal fistulae in the lower abdomen or pelvis can often be )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 197.3499 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 197.3499 Tm [(accurately delineated with a tailored MRI or CT)18.1( scan, but for those )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 185.6198 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 185.6198 Tm -.005 Tc (with a skin opening large enough to cannulate, a contrast fistulogram)Tj ET EMC /P <>BDC BT 8 0 0 8 554.3169 185.6198 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 173.8899 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 173.8899 Tm (may be useful in cases where diagnostic uncertainty remains. )Tj ET EMC /P <>BDC BT 8 0 0 8 533.4777 173.8899 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 156.4906 Tm -.125 Tc (10)Tj ET EMC /P <>BDC BT 8 0 0 8 308.9283 156.4906 Tm 0 Tc (.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 156.4906 Tm [(CT)18.1( is the best test in the diagnosis of acute obstruction, using a )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 144.7606 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 144.7606 Tm [(standard CT)18.1( rather than a CTE protocol \(in an acute setting oral )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 133.0306 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 133.0306 Tm [(contrast isnt usually appropriate\). BFT)18.1( can be useful in non-acute )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 121.3007 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 121.3007 Tm (presentations or where uncertainty remains.)Tj ET EMC /P <>BDC BT 8 0 0 8 469.0011 121.3007 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 103.9013 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 103.9013 Tm (Fluoroscopic cine images can provide a focused dynamic )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 92.1713 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 92.1713 Tm (assessment by allowing serial evaluation over the course of several )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 80.4413 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 80.4413 Tm [(\(usually 2-4\) hours. In dif)18.1(ficult cases when obstruction is clinically )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 68.7113 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 68.7113 Tm (suspected, real time fluoroscopy videos may demonstrate low )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 56.9813 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 56.9813 Tm (grade, intermittent obstruction \(most commonly due to adhesions\), )Tj ET EMC Q endstream endobj 112 0 obj <>/XObject<>/ExtGState<>>> endobj 116 0 obj <> endobj 154 0 obj <>stream /Figure <>BDC q 1 i -16 794.836 625.344 -936.03 re 297.645 420.96 m W* n 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS2 gs q 702.114 106.142 -80.977 535.654 11.868 -89.181 cm /Im1 Do Q EMC /P <>BDC Q q 1 i 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS1 gs BT /TT4 1 Tf 9 0 0 9 22.6772 814.1656 Tm 1 .15 0 0 k 0 Tc 0 Tw [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.781 595.29 1.4171 re f EMC /Artifact <>BDC 1 .1 0 .1 k .015015 0 595.29 31.482 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3583 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2007 14.3583 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /Artifact <>BDC 0 0 0 .08 k 36.85 421.945 520.425 176.924 re f EMC /P <>BDC BT 9 0 0 9 57.286 572.3123 Tm 1 .89 0 0 k (Suggested reading)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 165.286 572.3123 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 57.286 556.9777 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 65.79 556.9777 Tm [(Gupta )55.2(A, et al. \(2023\). Radiology in intestinal failure. In Intestinal Failure Second Edition. Ed: Nightingale JMD, Springer Na)]TJ 54.3628 0 TD (ture )Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 544.4777 Tm -.0552 Tw [(Switzerland AG. )-55.2(P469-488)]TJ ET EMC /P <>BDC BT 8 0 0 8 159.622 544.4777 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 57.286 531.9777 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 531.9777 Tm [(Cheng W)55.2(,)0( et al. \(2018\). )18.1(Three-dimensional CT)18.1( enterography versus barium follow-through examination in measurement of remnant )]TJ ET EMC /P <>BDC BT 8 0 0 8 65.79 519.4777 Tm [(small intestinal length in short bowel syndrome patients. )55.2(Abdom Radiol.; 43\(1)74.2(1\): 2955-2962)]TJ ET EMC /P <>BDC BT 8 0 0 8 387.6024 519.4777 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 57.286 506.9777 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 506.9777 Tm [(Sinha R, et al. \(2014\). Small-intestinal length measurement on MR enterography: comparison with in vivo surgical measurement. )55.2(A)]TJ 57.7495 0 TD (JR)Tj ET EMC /P <>BDC BT 8 0 0 8 561.286 506.9777 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 494.4777 Tm (Am J Roentgenol.; 203\(3\): W274W279.)Tj ET EMC /P <>BDC BT 8 0 0 8 209.8642 494.4777 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 57.286 481.9777 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 481.9777 Tm -.005 Tc [(de Jonge CS, et al. \(2018\). Evaluation of gastrointestinal motility with MRI: )55.2(Advances, challenges and opportunities. Neurogast)]TJ 55.2851 0 TD (roenterol)Tj ET EMC /P <>BDC BT 8 0 0 8 539.2866 481.9777 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 469.4777 Tm (Motil.; doi: 10.)Tj 6.2251 0 TD [(1)74.2(1)74.2(1)74.2(1/nmo.13257. )]TJ ET EMC /P <>BDC BT 8 0 0 8 178.3057 469.4777 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 57.286 456.9777 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 456.9777 Tm (Garzelli L, et al. \(2023\). Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric str)Tj 55.6373 0 TD (oke )Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 444.4777 Tm [(centre unit. Br J Radiol.; 96\(1)74.2(151\): 20230232. )]TJ ET EMC /P <>BDC BT 8 0 0 8 229.2978 444.4777 Tm ( )Tj ET EMC /P <>BDC BT 7 0 0 7 495.2301 15.0863 Tm 0 0 0 0 k (May 2024 | Page 3 of 3)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 782.0668 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 782.0668 Tm [(or dysmotility which can be dif)18.1(ficult to dif)18.1(ferentiate on static )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 770.3368 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 770.3368 Tm [(modalities such as CT)18.1( and MRI \(although newer emerging MRI )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 758.6068 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 758.6068 Tm (techniques described later may allow similar but less tailored )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 746.8768 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 746.8768 Tm (dynamic evaluation\). )Tj ET EMC /P <>BDC BT 8 0 0 8 126.0054 746.8768 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 729.3275 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 729.3275 Tm (For bowel ischaemia, most centres opt for a dual phase approach )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 717.4475 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 717.4475 Tm [(CT)110.8(, with an arterial phase to assess the arterial vasculature and )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 705.5675 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 705.5675 Tm (portal venous phases to assess bowel wall enhancement and )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 693.6875 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 693.6875 Tm [(mesenteric/portal venous system. )18.1(The appearances of bowel )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 681.8075 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 681.8075 Tm -.005 Tc [(ischaemia on CT)18.1( include: bowel wall thickening \(>3 mm\); mesenteric)]TJ ET EMC /P <>BDC BT 8 0 0 8 288.3942 681.8075 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 669.9275 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 669.9275 Tm (oedema and/ascites; decreased bowel wall enhancement; )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 658.0475 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 658.0475 Tm (pneumatosis \(intramural gas\) with or without associated gas in)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 646.1675 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 646.1675 Tm (the mesenteric/portal veins. Pneumatosis is a late sign and is )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 634.2875 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 634.2875 Tm [(suggestive of infarction. )18.1(The vasculature should be carefully )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 622.4075 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 622.4075 Tm (scrutinised, with accompanying knowledge of the arterial supply )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 610.5275 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 610.5275 Tm (and venous drainage of the bowel.)Tj ET EMC /P <>BDC BT 8 0 0 8 170.5016 610.5275 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 782.0668 Tm -.1642 Tc [(11)-74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 782.0668 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 782.0668 Tm -.005 Tc (Mapping means determining the length, type and quality of bowel )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 770.1868 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 770.1868 Tm -.005 Tc (remaining in and out of circuit and an assessment of any fistula )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 758.3068 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 758.3068 Tm -.005 Tc (and the abdominal wall. It is done before any planned procedure, )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 746.4268 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 746.4268 Tm -.005 Tc (often)Tj ET EMC /P <>BDC BT 8 0 0 8 330.9614 746.4268 Tm 0 Tc [( to restore bowel continuity)74.2(. Bowel length can be determined )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 734.5468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 734.5468 Tm [(by one or more of a CT)110.8(, MR enterography or BFT)110.8(, and providing )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 722.6667 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 722.6667 Tm (the )Tj ET EMC /P <>BDC BT 8 0 0 8 327.5416 722.6667 Tm (remaining SB length is less than 2 m, the result correlates )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 710.7868 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 710.7868 Tm (well with a surgical measurement.)Tj ET EMC /P <>BDC BT 8 0 0 8 433.4152 710.7868 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 693.2175 Tm -.09 Tc (12.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 693.2175 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 693.2175 Tm [(Review of all available imaging studies at an MDT)110.8(, ensuring both)]TJ ET EMC /P <>BDC BT 8 0 0 8 310.5337 681.3175 Tm ( recent and past scans from all hospitals are available, can be critical)Tj ET EMC /P <>BDC BT 8 0 0 8 554.2134 681.3175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 669.4175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 669.4175 Tm (to finding answers not available from a single exam, particularly for )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 657.5175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 657.5175 Tm (all complex patients or where uncertainty remains regarding critical )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 645.6175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 645.6175 Tm -.005 Tc [(questions. )18.1(This is especially important prior to reconstructive surgery)]TJ ET EMC /P <>BDC BT 8 0 0 8 553.151 645.6175 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 633.7175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 633.7175 Tm [(as delineating bowel length quality and surrounding anatomy)74.2(, is )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 621.8175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 621.8175 Tm (critical so the surgeon can be advised about the best surgical site )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 609.9176 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 609.9176 Tm [(to gain safe access to the abdominal cavity)74.2(.)]TJ ET EMC /P <>BDC BT /TT4 1 Tf 6 0 0 6 36.8504 408.1299 Tm (Disclaimer:)Tj ET EMC /P <>BDC BT /TT2 1 Tf 6 0 0 6 69.2 408.1299 Tm ( ϳԹ Position Statements/Guidelines have been prepared as guidance only to assist qualified healthcare professionals in the d)Tj 57.4793 0 TD (ecision-making processes surrounding nutritional)Tj ET EMC /P <>BDC BT 6 0 0 6 544.1434 408.1299 Tm ( )Tj ET EMC /P <>BDC BT 6 0 0 6 36.8504 400.1299 Tm (care. Users of these materials may only do so on the condition that they exercise their own professional knowledge and skills w)Tj 56.1952 0 TD [(hen applying such guidance to specific circumstances. )55.2(Anyone )]TJ ET EMC /P <>BDC BT 6 0 0 6 36.8504 392.1299 Tm (without the appropriate qualifications must seek the advice of a qualified healthcare professional before taking, or refraining)Tj 54.4212 0 TD ( from, any action on the basis of the policies or guidance. ϳԹ does)Tj ET EMC /P <>BDC BT 6 0 0 6 551.4852 392.1299 Tm ( )Tj ET EMC /P <>BDC BT 6 0 0 6 36.8504 384.1299 Tm (not \(i\) owe a duty of care to users of the policies, guidance or practice tips who are not qualified healthcare professionals; )Tj 53.8075 0 TD (and \(ii\) cannot accept liability to anyone using these policies, guidance)Tj ET EMC /P <>BDC BT 6 0 0 6 576.8504 384.1299 Tm ( )Tj ET EMC /P <>BDC BT 6 0 0 6 36.8504 376.1299 Tm (or practice tips.)Tj ET EMC Q endstream endobj 155 0 obj <>/XObject<>/ExtGState<>>> endobj 6 0 obj <> endobj 5 0 obj <> endobj 113 0 obj <>stream Adobed         #"""#''''''''''     !! !!''''''''''Z""  s!1AQa"q2B#R3b$r%C4Scs5D'6Tdt& EFVU(eufv7GWgw8HXhx)9IYiy*:JZjzm!1AQa"q2#BRbr3$4CS%cs5DT &6E'dtU7()󄔤euFVfvGWgw8HXhx9IYiy*:JZjz? a8թ8S@z@}x9$pT7ڥS?vlٛ؏g0hcL2׀1ٳZE~\[%>39>!V3ǖwwl乔i9)ӿ+?0@ V,MB 8#tTQTbi]^.NˏU<'͞X{K!er$v7 C$OԽ<Bf{;e_f?sp1k8d{u[TavhË?iAuqnuByMw:Y`)/1K004!iF}4i~,kM Ȟ`}V}gYw9TQce9[ڽ΋#'͏q\v&I8P:mw.-E #E|wgFr2"I>g6lٳfȫf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͋Zmn"TŜHۉG2礿.ð%ck۠!AN'SOfj-p)4 DZ;ٚ-FO\Y!2CzC|fny&-%}:pO¸[q y0vVbr~0*ϺiIBkv>h:zkv&{եfKKWh.2 q>`Ȏxf3)/8㇔S $ ToR(O|!iTy['+7G=)O~b{<[ep-_*Pv*~y˳`OFYc7hbxuG9O$L%d8d*6j6lٳdٳf͛6lUٳf͛6lUٳf͛6lUٳf͛>U\ٳf͛(uvlٲd~m>H.Xਪ/O>"_ffY.wWJ)mٛN$Ҽ;I,^Iff5,I9{ 7M@C|q>Sc0^mJ][[kveTtHl;g˓,,s&R#̒ylٳf͛+Wf͛6lٱWf͛6ls*7?Uto\P;i_DOpϒ8cYaG#r͛, 6.K6H FFUsWq>^p37S=#Gt?->Zc?wC$݉?qzCy +YiLgH0heL|a58`|ϪϬ3;>q f˗&\˖Fs))JG'$f͛6lZ6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6l;GQմnqJ T; 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