Ultrasound for Small Bowel Obstruction
Small bowel obstruction (SBO) can be a big problem if we don't recognise it quickly - bowel necrosis, perforation, sepsis and death are among the potential consequences. History and examination can suggest the diagnosis, but blood tests are largely unhelpful. This is a condition that is almost always diagnosed on imaging, and our usual go-to is the abdominal X-ray (AXR).
The problem is that they're not always as obvious as the above X-ray. AXR actually performs rather poorly as a diagnostic test for SBO, with less than 70% sensitivity on average. This has led to some researchers deriding it as "the least useful imaging modality for the diagnosis of SBO", and others maintaining, "there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain".
Have you ever had a SBO with a normal AXR? I know I have, because dilated, oedematous, fluid-filled loops don't show up on plain films. Luckily for my patient, there was sufficient clinical suspicion to get a CT so no harm was done. But CTs are expensive, time-consuming (there's usually a queue!), expose the patient to radiation, and necessitate potentially unsafe journeys away from the Emergency Department.
So is there an alternative solution? Does ultrasound really have a role here? Let's find out...
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