Bedside ultrasonography for the detection of small bowel obstruction in the emergency department

• Published in: Emergency medicine journal : EMJ Vol. 28; no. 8; pp. 676 - 678
• Main Authors: Jang, Timothy B, Schindler, Danielle, Kaji, Amy H
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01.08.2011; BMJ Publishing Group LTD
• Subjects: Abdomen; Abdomen non-trauma; Abdominal Pain - diagnostic imaging; Adult; Aged; Aged, 80 and over; Bias; Emergency medical care; Emergency Service, Hospital; Female; gastro-intestinal; Humans; imaging; Intestinal Obstruction - diagnostic imaging; Intestine, Small - diagnostic imaging; Male; Middle Aged; Nausea; Pain; Participation; Point-of-Care Systems; Prospective Studies; Sensitivity and Specificity; Studies; Tomography, X-Ray Computed; Ultrasonography; ultrasound; Vomiting
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emj.2010.095729

BackgroundPlain film radiography (x-ray) is often the initial study in patients with suspected small bowel obstruction (SBO) to expedite patient care.ObjectiveTo compare bedside ultrasonography (US) and x-ray for the detection of SBO.MethodsThis was a prospective study using a convenience sample of patients presenting to the emergency department (ED) with abdominal pain, vomiting, or other symptoms suggestive of a SBO. Patients were evaluated with US prior to x-ray and CT. US was performed by emergency physicians (EPs) who completed a 10 min training module and five prior US exams for SBO. The criterion standard for the diagnosis of SBO was the results of CT read by board-certified radiologists.ResultsIn all, 76 patients were enrolled and evaluated with US for SBO. A total of 33 (43%) were diagnosed as having SBO. Dilated bowel on US had a sensitivity of 91% (95% CI 75 to 98%) and specificity of 84% (95% CI 69 to 93%) for SBO, compared to 27% (95% CI 14 to 46%) and 98% (95% CI 86 to 100%) for decreased bowel peristalsis on US. x-Ray had a sensitivity of 46.2% (95% CI 20.4 to 73.9%) and specificity of 66.7% (95% CI 48.9 to 80.9%) for SBO when diagnostic, but was non-diagnostic 36% of the time.ConclusionEP-performed US compares favourably to x-ray in the diagnosis of SBO.