Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies – An EFSUMB Position Paper

Abstract

An interdisciplinary group of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of three time-critical causes of acute abdomen: bowel obstruction, gastrointestinal perforation and acute ischemic bowel disease. Based on an extensive literature review, statements for a targeted diagnostic strategy in these intestinal emergencies are presented. GIUS is best established in case of small bowel obstruction. Metanalyses and prospective studies showed a sensitivity and specificity comparable to that of computed tomography (CT) and superior to plain X-ray. GIUS may save time and radiation exposure and has the advantage of displaying bowel function directly. Gastrointestinal perforation is more challenging for less experienced investigators. Although GIUS in experienced hands has a relatively high sensitivity to establish a correct diagnosis, CT is the most sensitive method in this situation. The spectrum of intestinal ischemia ranges from self-limited ischemic colitis to fatal intestinal infarction. In acute arterial mesenteric ischemia, GIUS may provide information, but prompt CT angiography is the gold standard. On the other end of the spectrum, ischemic colitis shows typical ultrasound features that allow correct diagnosis. GIUS here has a diagnostic performance similar to CT and helps to differentiate mild from severe ischemic colitis.

Clinical Awareness and Acceptance of Sonographically Diagnosed Epiploic Appendagitis (EA): A Retrospective Analysis of EA in a Single Tertiary Academic Referral Center

“…However, ultrasound should be used in non-critical patients for better efficiency and targeted use of CT examination 16 . Even in rare congenital and acquired abdominal diseases, ultrasound patterns have already been described 18 19 20 21 22 23 24 25 26 .…”

Mors Gaudet Succurrere Vitae. The Role of Clinical Autopsy in Preventing Litigation Related to the Management of Liver and Digestive Disorders

“…Concerning diagnostic imaging, the results obtained alternately show concordance and discrepancy with the literature data, highlighting interesting aspects relating to the diagnostic classification of patients, especially in emergency contexts. According to the current evidence, given the non-specificity of the symptoms, a timely approach based on the execution of abdominal ultrasound, CT scan, and X-rays in case of suspected bowel obstruction is of primary utility to establish any urgency; despite the dependence on the operator, ultrasound is the first assessment that should be performed to establish the real presence of an obstruction, especially in the case of involvement of the small intestine (sensitivity 90-92.4%; specificity 96-96.7%) [33,34]; a similar diagnostic capacity is comparable to the CT and better than X-rays (sensitivity 75%; specificity 66%) [35]. Conversely, CT scan is more accurate in identifying the cause of the obstruction.…”

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“…Beyond doubt, conventional ultrasound remains a mainstay for the initial evaluation of acute abdominal symptoms [ 2 , 3 ]. In addition, ultrasound is recommended as the primary imaging modality in the context of screening patients with chronic liver and kidney diseases, who thus are prone to cancer development [ 5 , 21 ].…”

“…Conventional ultrasound, comprising native B-mode and Color Doppler, is frequently applied as an imaging modality for initial abdominal investigation, including kidney and liver imaging [ 1 , 2 , 3 ]. Ultrasound is applied as a screening tool in patients with chronic diseases, who thus are predisposed to developing cancer, e.g., renal cell carcinoma (RCC) or hepatocellular carcinoma (HCC) [ 4 , 5 ].…”