These ultrasounds, performed by Dr. Ricot, R1 EM resident at HUM, nicely demonstrate sonographic findings consistent with a small bowel obstruction.
How to perform: Using the curvilinear (abdominal) probe, scan carefully through the entire abdomen, including the epigastricum, bilateral colic gutters, and suprapubic region looking closely at the most dependent portions where fluid-filled loops are most easily identified.
The finding most suggestive of a small bowel obstruction are fluid-filled small bowel loops dialed > 2.5cm. Depending on the degree of obstruction, you may also see increased peristalsis, which appears as “to-and-fro” movement of the bowel contents as the contents move back and forth within a bowel loop (this is easily seen in the 1st video). Another prominent finding to look for is the “keyboard sign,” which refers to the valvulae conniventes (also called plicae circulares), which are finger-like projections on the inner wall of the jejunum that become prominent during an obstruction.
If you see intestinal wall thickening greater than 3mm, fluid outside of the lumen of the intestine, or the absence of peristalsis, consider calling the surgeons IMMEDIATELY as these signs suggest that bowel ischemia/infarction.
So how good is ultrasound at diagnosing bowel obstruction??
This is a relatively new use of ultrasound in the emergency department but recent studies are promising. One study in the Emergency Medicine Journal in 2011 found that after only 10 minutes of instruction, emergency medicine residents were able to diagnose small bowel obstruction with ultrasound with greater sensitivity and specificity than plain film x-rays (91% and 84% vs. 46% and 67%).
More information:
Ultrasound Podcast – Small Bowel Obstruction
