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

Published online by Cambridge University Press:  01 April 2015

Joshua Guttman ,
Michael B. Stone ,
Heidi H. Kimberly  and
Joshua S. Rempell
Joshua Guttman*
Affiliation:
Emergency Medicine Residency Program, McGill University Health Centre, Montreal, QC
Michael B. Stone
Affiliation:
Division of Emergency Ultrasound, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
Heidi H. Kimberly
Affiliation:
Division of Emergency Ultrasound, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
Joshua S. Rempell
Affiliation:
Division of Emergency Ultrasound, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
*
Correspondence to: Dr. Joshua Guttman, Emergency Medicine Residency Program, McGill University Health Centre, 687 Pine Avenue West, Room A4.62, Montreal, QC H3A 1A1; [email protected]

Abstract

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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.

Résumé

L’occlusion de l’intestin grêle (OIG) est une cause fréquente de douleur abdominale aiguë au service des urgences (SU). Malgré une documentation peu abondante, l’échographie au point de service (EPS) se révè le supérieure à la radiographie simple quant à l’exactitude diagnostique dans l’OIG; toutefois, l’emploi de l’EPS dans ce contexte est peu étendu en Amérique du Nord. Sera exposé dans l’article le cas d’un homme d’âge mûr, qui a consulté pour des douleurs abdominales; le recours à l’EPS par l’urgentologue peu de temps après l’arrivée à l’hôpital a permis d’accélérer la pose du diagnostic d’OIG et de demander rapidement une consultation en chirurgie. L’application de l’EPS dans l’OIG s’apprend et s’applique facilement au SU. L’EPS dans le contexte de l’OIG peut ainsi rendre obsolète la radiographie simple et accélérer les soins aux patients.

Type
Case Report
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 2 , March 2015 , pp. 206 - 209
Copyright
Copyright © Canadian Association of Emergency Physicians 2015 

References

1. Torrey, S, Henneman, P. Disorders of the small intestine. In: Marx JA editor Rosen’s emergency medicine: concepts and clinical practice, 7th ed. Philadelphia Elsevier; 2010, p 1184–1192.Google Scholar
2. Maung, AA, Johnson, DC, Piper, GL, et al.. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012;73(5 Suppl 4):S362–9, doi:10.1097/TA.0b013e31827019de.Google Scholar
3. Suri, S, Gupta, S, Sudhakar, PJ, et al.. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol 1999;40:422–428, doi:10. 3109/02841859909177758.Google Scholar
4. Ogata, M, Mateer, JR, Condon, RE. Prospective evaluation of abdominal sonography for the diagnosis of bowel obstruction. Ann Surg 1996;223:237–241, doi:10.1097/00000658-199603000-00002.CrossRefGoogle ScholarPubMed
5. Unluer, EE, Yavasi, O, Eroglu, O, et al.. Ultrasonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction. Eur J Emerg Med 2010;17:260–264, doi:10.1097/MEJ.0b013e328336c736.Google Scholar
6. Jang, TB, Schindler, D, Kaji, AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J 2011;28:676–678, doi:10.1136/emj.2010.095729.Google Scholar
7. Grassi, R, Romano, S, D’Amario, F, et al.. The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults. Eur J Radiol 2004;50:5–14, doi:10.1016/j.ejrad.2003.11.009.Google Scholar
8. Ko, YT, Lim, JH, Lee, DH, et al.. Small bowel obstruction: sonographic evaluation. Radiology 1993;188:649–653.Google Scholar
9. Czechowski, J. Conventional radiography and ultrasonography in the diagnosis of small bowel obstruction and strangulation. Acta Radiol 1996;37:186–189, doi:10.3109/02841859609173442.Google Scholar
10. Schmutz, GR, Benko, A, Fournier, L, et al.. Small bowel obstruction: role and contribution of sonography. Eur Radiol 1997;7:1054–1058, doi:10.1007/s003300050251.Google Scholar
11. Chen, SC, Wang, HP, Chen, WJ, et al.. Selective use of ultrasonography for the detection of pneumoperitoneum. Acad Emerg Med 2002;9:643–645, doi:10.1111/j.1553-2712.2002.tb02307.x.Google Scholar