Abstract
Small bowel obstruction (SBO) is a relatively common presentation to the Emergency Department (ED), accounting for up to 15% of surgical admissions. Since the indications for and timing of surgical intervention for SBO have changed over the past decades, staging SBO is crucial. The management depends on the etiology, severity, and location of the obstruction, but most cases do not require operative intervention. Although contrast-enhanced computed tomography (CT) remains the gold-standard diagnostic imaging, point-of-care ultrasound (POCUS) can be highly accurate in the diagnosis of SBO in the ED, defining the presence or absence of parietal damage. The main features for US diagnosis of SBO include: presence of fluid-filled, dilated bowel loops (≥25 mm); absent or ineffective peristalsis (“to-and-fro” appearance of intra-luminal contents); free fluid between the dilated loops (“tanga sign”); and collapsed colonic lumen. The US diagnosis of large bowel obstruction rely on similar findings (empty colon distally of a “mass like” colonic lesion, enlarged colon with/without dilated small bowel loops, free fluid, possible metastatic lesions), but its role has a reduced impact on clinical decision-making than for SBO.
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4.1 Electronic Supplementary Materials
To-and-fro sign (MP4 30345 kb)
Tanga sign (MP4 108327 kb)
DPA (MP4 30123 kb)
Appendix: Chapter 4—Test Yourself (Answers in the Appendix at the End of the Book)
Appendix: Chapter 4—Test Yourself (Answers in the Appendix at the End of the Book)
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Q1—Look at Fig. 4. How dilated is the bowel loop?
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20 mm
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30 mm
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50 mm
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Q2—What do you need to search for confirming an SBO on US?
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dilated stomach
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dilated colon
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empty distal small bowel
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Marconi, M., Kurihara, H., Martinez Casas, I., Ünlüer, E.E., Guerrini, J., Zago, M. (2023). Bowel Obstruction: The Clinical Questions Can Be Answered by US. In: Zago, M., Troian, M., Mariani, D. (eds) Point-of-care US for Acute Abdomen. Springer, Cham. https://doi.org/10.1007/978-3-031-40231-9_4
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