Keywords:
Gastrointestinal tract, Abdomen, Ultrasound, Ultrasound-Colour Doppler, Ultrasound-Power Doppler, Diagnostic procedure, Obstruction / Occlusion
Authors:
F. Iacobellis1, D. Berritto2, F. Somma1, M. P. Belfiore1, S. Cappabianca2, A. Rotondo2, R. Grassi2; 1Napoli/IT, 2Naples/IT
DOI:
10.1594/ecr2012/C-2065
Conclusion
Active collaboration between radiologist,
emergency physicians,
and general surgeons is necessary to optimize the diagnostic evaluation and management in SBO.
The role of radiologists is to confirm the obstruction,
establish the cause,
determine the level,
and predict whether strangulation is present.
The diagnosis of SBO can be made with plain abdominal films in 50-60% of cases.
However this technique may be unremarkable in 20% of cases.
The role of US has been widely applied to evaluate various abdominal diseases and several articles have dealt with the usefulness of US in SBO (4-6).
Previous investigations revealed a good sensitivity of US: 89% compared with 71% for plain abdominal films in diagnosing of SBO (3) and showed this technique to be better than plain abdominal films in establishing a diagnosis of SBO and differentiating between paralytic ileus and mechanical obstruction.
US,
where expertise and equipment is available,
should be the initial investigation in patients presenting with SBO whereas plain abdominal films should only be used as a complementary tool.
The advantages of US are the early detection of rising signs of SBO,
such as dynamic evaluation,
which other static radiological procedures cannot supply.
The possibility of identifying the early changes in free fluid amount confirms that this technique can play an important role in monitoring the evolution of SBO.
Furthermore this is a non-invasive tool,
not requiring radiation exposure or contrast medium administration (7).
The assumption of a parallelism between the experimental SBO in this animal model and humans is reasonable (8,9).
This study allows to document the chronological evolution of bowel injury consequent to bowel obstruction and to confirm the important role of US in the diagnostic assessment of this pathology.
Our results confirm that the onset and the increase of free fluid around the occluded loop and in abdominal cavity detected by US is directly related to the worsening of SBO,
thus this finding helps to identify the best time for a medical or surgical treatment.
Furthermore the study proves that serial US examination should be used to evaluate the persistence and the increase of free fluid and to determine the proper therapy.
In this case US is considered an effective and advantageous imaging test since it is non-invasive and can be repeated to monitor patient over time.