GI: How does a bowel obstruction show up on Xray but not CT?

[Meerkat]

This week, I had all the symptoms of bowel obstruction. Extreme stomach cramping, inability to 'go', vomiting, etc. Enema, suppository...nothing worked. Finally had to resort to the unpleasant task of gloving up and digitally attempting to get clear. (Sorry for being so graphic). The pain was horrible, there was frank blood. I sat on an icepack for two days.

Last night I was cramping so badly and still incredibly nauseated, so I went to the ER. Positive blood upon exam. Had abdominal XRay. As the Xray tech was wheeling my back, he asked a few questions that caused me to believe that he was able to see a problem on the films, so I asked him. He said 'well, there;s defiitely something there, it sure isn't your imagination'. Then the P.A. came back in the room and said he saw a huge dilated bowel the size of an orange...I was really relieved that we were making progress with the dx.

Then there was a shift change. The doc who took over ordered a CT scan. He said it showed nothing abnormal and sent me home with some Preperation H and a list of GI docs to call on Monday. I felt like crying...I thought I was going to get some relief! How could a 'large dilated bowel' show up on Xray, clear enough that the tech could see it, but then 'nothing' show up on CT?

I am not in much pain today at all..BUT I have not tried to 'go' and I cannot tell if I have to or not. Actually, I'm scared to try.

Does anyone know how two practitioners could have arrived at totally opposite conclusions based on Xray and CT?

Thanks!

[mommatrauma, RN]

Ok with the disclaimer that i am not a doctor, I will offer my suggestion...There are more things than simply bowel obstructions that will dilate bowel loops...ie infection, divertic, fecal impaction...etc...Your symptoms although consistent with bowel obstruction could also be consistent with a fecal impaction...which would certainly show up on a flat plate of the abd with dilated bowel loops...if there were no air fluid levels, there was probably no obstruction so to speak....As for the CT Scan...the fact that it was "negative" could simply mean that there is no obstruction or nothing life threatening going on despite the symptoms you were having...and all could have simply been from an impaction...The frank blood you were seeing, could certainly been from when you tried to manually disempact yourself, or the simple act of straining...I'm not sure if this all makes sense or even if that's what it all means...I'm sorry you weren't feeling well and hope you are feeling better soon!