<![CDATA[Paralytic subileus is a complication of abdominal trauma resulting from traffic accidents, characterized by a partial disruption of intestinal peristaltic contractions. A three-view abdominal radiographic series (AP supine, AP semi-erect, and Left Lateral Decubitus/LLD) is typically used to aid diagnosis; however, the LLD position is difficult to implement for hemodynamically unstable trauma patients. At Jakarta Islamic Hospital Pondok Kopi, the three-view abdominal examination for suspected post-accident paralytic subileus utilizes AP supine, AP semi-erect, and AP Horizontal projections. This study aims to examine the procedure and the rationale for using the AP Horizontal projection. It is a qualitative study employing a descriptive case study approach, conducted at the Radiology Department of Jakarta Islamic Hospital Pondok Kopi from September 2025 to May 2026. The study covers patient preparation, equipment and materials, examination techniques and projections (AP supine, AP semi-erect, and AP Horizontal as a modification of LLD), and the clinical justification for the AP Horizontal projection. The study subjects consisted of three radiographers and one radiologist. Data were collected through observation, interviews, literature review, and documentation, followed by analysis involving data reduction, data presentation, and conclusion drawing. The examination was performed without special preparation, other than the removal of metal objects to prevent artifacts. The technique employed AP supine, AP semi-erect, and AP Horizontal projections—substituting the LLD view—prioritizing patient safety, as the trauma condition precluded tilting the patient's body. The AP Horizontal projection successfully demonstrated air-fluid levels and free air comparable to the LLD view, yielding optimal radiographic quality that supported the diagnosis of paralytic subileus. Modifying the LLD projection to the AP Horizontal projection proved safe, effective, and diagnostically equivalent for suspected paralytic subileus cases in emergency post-accident patients, making it a suitable practice to maintain within emergency radiography protocols.]]>
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