Strangulating Closed-Loop Obstruction: Sonographic Signs

Hollerweger, Alois; Rieger, S.; Mayr, Norbert; Mittermair, Christof; Schaffler-Schaden, Dagmar

doi:10.1055/s-0034-1398988

Cited by 4 publications

(3 citation statements)

References 2 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…USD findings that suggest the need for urgent surgery include intraperitoneal free fluid, mural thickness >4 mm, and decreased or absent peristalsis in mechanically obstructed bowel. The sonographic signs of akinetic bowel loops, hyperechoic thickening of attached mesentery, and free peritoneal fluid are typical of strangulation [78].…”

Section: Abdominal Ultrasoundmentioning

confidence: 99%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

167

111

View full text Add to dashboard Cite

SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn's disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks. Classical clinical tetrad is abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation. Physical exam may reveal restlessness, acute illness, and signs of dehydration and sepsis, including tachycardia, pyrexia, dry mucous membranes, hypotension/orthostasis, abdominal distention, and hypoactive bowel sounds. Severe direct tenderness, involuntary guarding, abdominal rigidity, and rebound tenderness suggest advanced SBO, as do marked leukocytosis, neutrophilia, bandemia, and lactic acidosis. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction. Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting/characterizing SBO. SBO usually resolves with medical therapy but requires surgery, preferentially by laparoscopy, for unremitting total obstruction, bowel perforation, severe ischemia, or clinical deterioration with medical therapy. Overall mortality is 10% but increases to 30% with bowel necrosis/perforation. Key point in SBO is early diagnosis, emphasizing abdominal CT; aggressive medical therapy including rehydration, antibiotics, and nil per os; and surgery for failed medical therapy.

show abstract

Section: Abdominal Ultrasoundmentioning

confidence: 99%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

167

111

View full text Add to dashboard Cite

show abstract

“…From the practical point of view, the detection of ischemia in the presence of obstruction, is one of the most important decisions in patients with bowel obstruction, to identify patients who require early surgery. Sonographic findings suggesting the need for surgery include intraperitoneal free fluid, bowel wall thickness > 4 mm, decreased or absent peristalsis in documented mechanical obstruction, absence or reduced bowel wall perfusion at Doppler sonography or with IV contrast-enhanced ultrasound (CEUS) and, in advanced stages free intraperitoneal gas indicating bowel perforation [27,35,[49][50][51]. However, after the encouraging preliminary results with the use of firstgeneration contrast agents, no further studies have confirmed whether CEUS can accurately detect ischemia in the presence of bowel strangulation [52][53][54].…”

Section: Sonographic Signs Of Complicationmentioning

confidence: 99%

Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies – An EFSUMB Position Paper

et al. 2020

View full text Add to dashboard Cite

An interdisciplinary group of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of three time-critical causes of acute abdomen: bowel obstruction, gastrointestinal perforation and acute ischemic bowel disease. Based on an extensive literature review, statements for a targeted diagnostic strategy in these intestinal emergencies are presented. GIUS is best established in case of small bowel obstruction. Metanalyses and prospective studies showed a sensitivity and specificity comparable to that of computed tomography (CT) and superior to plain X-ray. GIUS may save time and radiation exposure and has the advantage of displaying bowel function directly. Gastrointestinal perforation is more challenging for less experienced investigators. Although GIUS in experienced hands has a relatively high sensitivity to establish a correct diagnosis, CT is the most sensitive method in this situation. The spectrum of intestinal ischemia ranges from self-limited ischemic colitis to fatal intestinal infarction. In acute arterial mesenteric ischemia, GIUS may provide information, but prompt CT angiography is the gold standard. On the other end of the spectrum, ischemic colitis shows typical ultrasound features that allow correct diagnosis. GIUS here has a diagnostic performance similar to CT and helps to differentiate mild from severe ischemic colitis.

show abstract

“…It has been shown to be more sensitive and specific for obstruction than x-ray, and can be performed accurately by emergency providers. [172][173][174] Pneumoperitoneum can be also diagnosed by US with high sensitivity and specificity, and due to its availability and speed, has been proposed as a screening tool in the acute abdomen. In some countries, US is the first line imaging modality for the diagnosis of diverticulitis.…”

Section: Bowelmentioning

confidence: 99%

Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine

2017

Annals of Emergency Medicine

485

120

View full text Add to dashboard Cite

Strangulating Closed-Loop Obstruction: Sonographic Signs

Cited by 4 publications

References 2 publications

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies – An EFSUMB Position Paper

Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine

Contact Info

Product

Resources

About