Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction.

Stefania Tamburrini,Francesco Somma,Carlo Liguori,Roberta Abete,Pasquale Tammaro,Ines Marano,Giuseppe Sarti,Nicola Serra,Gabriella Toro,Andrea Ferraro,Giuseppe Mercogliano,Maria Vittoria Guerra,Roberto Carbone,Ylenia Mandato,Marina Lugarà

doi:10.3390/diagnostics10050277

Stefania Tamburrini, Francesco Somma + Show 13 more

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https://doi.org/10.3390/diagnostics10050277

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Abstract

Ultrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). Because the indications for and timing of surgical intervention for SBO have changed over the past several decades, there is a widespread assumption that the majority of patients with simple SBO may be conservatively managed; in this scenario, staging SBO is crucial. This study evaluated the association between morphological and functional US signs in the diagnosis and staging (simple, decompensated and complicated), and the associations and prevalence of US signs correlated with clinical or surgical outcome. The US signs were divided into diagnostic (dilated bowel loops and altered kinesis) and staging criteria (extraluminal free fluid, parietal and villi alterations). We performed a retrospective, single-center cohort, observational study examining the prevalence of morphologic and functional US signs in the staging of simple, decompensated and complicated SBO. The most significant US signs were dilated bowel loops (100%), hypokinesis (90.46%), thickened walls (82.54%) and free fluid (74.60%). By linear regression, free fluid was positively correlated to US staging in both univariate and multivariate analysis; that is, the more advanced the stage of SBO, the more probable the presence of free fluid between the bowel loops. In univariate analysis only, we found a positive correlation between US staging/thickened walls and the prominence of valvulae conniventes. Additionally, the multivariate analysis indicated that parietal stratification and bowel jump kinesis were negative predictors for US staging in comparison to other US signs. In addition, we found significant associations between conservative treatment or surgery and hypokinesis (p = 0.0326), akinesis (p = 0.0326), free fluid (p = 0.0013) and prominence of valvulae conniventes (p = 0.011). Free fluid in particular was significantly less present in patients that were conservatively treated (p = 0.040). We conclude that the US staging of SBO may be crucial, with a valuable role in the initial diagnosis and staging of the pathology, saving time and reducing total radiation exposure to the patient.

Highlights

IntroductionCT represents the gold-standard imaging modality in the evaluation of small bowel obstruction (SBO), answering to all diagnostic key points; it can confirm the pathology, determine the cause and level of mechanical obstruction and stage SBO, defining the presence or the absence of parietal damage
Small bowel obstruction (SBO) is a common emergency department (ED) diagnosis; small bowel obstruction (SBO) may be functional, due to bowel wall or splanchnic nerve dysfunction, or mechanical
Recent studies demonstrated that ultrasound (US) and bedside point-of-care ultrasound (POCUS) have a reasonably high accuracy in diagnosing small bowel obstruction compared with CT scan, representing a rapid diagnostic modality to diagnose SBO, determining the presence or absence of pathology and substantially decreasing the time to diagnosis [10,11,12,13,14,15,16,17,18]

Summary

Introduction

CT represents the gold-standard imaging modality in the evaluation of SBO, answering to all diagnostic key points; it can confirm the pathology, determine the cause and level of mechanical obstruction and stage SBO, defining the presence or the absence of parietal damage. Recent studies demonstrated that ultrasound (US) and bedside point-of-care ultrasound (POCUS) have a reasonably high accuracy in diagnosing small bowel obstruction compared with CT scan, representing a rapid diagnostic modality to diagnose SBO, determining the presence or absence of pathology and substantially decreasing the time to diagnosis [10,11,12,13,14,15,16,17,18]. Because stable patients with an ultrasound diagnosis of simple small bowel obstruction can be expeditiously admitted to the hospital in the surgical department, avoiding the need for a CT scan in the ED settings [11], decreasing health care (decompensated and complicated)

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