Point-of-care ultrasonography for the diagnosis of small bowel obstruction in the emergency department

Abstract

Small bowel obstruction (SBO) is a common cause of acute abdominal pain presenting to the emergency department (ED). Although the literature is limited, point-of-care ultrasonography (POCUS) has been found to have superior diagnostic accuracy for SBO compared to plain radiography; however, it is rarely used in North America for this. We present the case of a middle-aged man who presented with abdominal pain where POCUS by the emergency physician early in the hospital course expedited the diagnosis of SBO and led to earlier surgical consultation. The application of POCUS for SBO is easily learned and applied in the ED. POCUS for SBO may obviate the need for plain radiography and expedite patient care.

Imaging of a rare case of Bochdalek hernia in an adult female

“…5 Both early diagnosis with proper imaging and prompt operative management lead to good results, as our case demonstrates. Finally, as in our case, the ultrasonography has been found also able to show bowel obstruction, 6 but it does not rule out a clear definition of intestinal occlusion. 7 Thus, computed tomography is the most accurate method able to confirm the presence of diaphragmatic herniation as well as the presence of intestine in the thorax and its localization as cause of intestinal occlusion 8,9 and facilitating the best management of this condition.…”

日本救急医学会 救急point–of–care超音波診療指針(Guidance for Clinical Practice using Emergency and Point–of–Care Ultrasonography)

“…2010年代に入り，腸閉塞の超音波検査に関する研究が次々と発表され 114), 115), 116), 117), 118), 119)，Gottliebらは感度92%，特異度97%と報告した 114)。一方，Beckerらによる多施設前向き観察研究によると，救急医が実施した超音波検査では感度88%，特異度54%と精度に限界があった 120)。同研究では，救急のフェロー研修を終えた医師による特異度は82%と比較的高く，腸閉塞の超音波診断を行うには集中的なPOCUSのトレーニングが必要であると結論づけている。…”

Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine

“…POCUS enables visualization of dilated fluid-filled bowel loops, changes in peristalsis and collapsed distal bowel. It has demonstrated superior sensitivity and specificity to plain abdominal radiographs for bowel obstruction [35,36].…”