When looking into someone’s abdomen, the first thing you'll notice is that it almost looks like there is nothing there. For Dr. Lauren Westafer, the gut looks like a black box. There's a lot of gas which makes it hard to see arteries and organs. In this podcast, Lauren discusses point of care Intestinal Ultrasound. To do an intestinal ultrasound, first, rub the curvilinear probe over the abdomen... That's it as far as technique is concerned! There is nothing overly complicated for such a useful procedure. Why do we still need an ultrasound for small bowel obstructions when we already have other tools like patient history, a physical exam, and x-ray? Unfortunately, these tools are all unreliable for diagnosing small bowel obstructions. What's more, the training for gut ultrasound doesn't take much time. It takes around 10 minutes to do 5-10 scans. The scanning procedure itself takes less than five minutes to perform. For such a high-value procedure, it takes an incredibly low amount of effort and time! When conducting a gut ultrasound, you are looking for dilated bowel (greater than 2.5 cm) and abnormal peristalsis. Lauren explains exactly what to look for, especially when recognising patterns of abnormal peristalsis. Lauren encourages us to embrace a gut ultrasound. From DAS SMACC, tune in to a discussion on Point of Care Intestinal Ultrasound by Lauren Westafer. For more like this, head to our podcast page. #CodaPodcast

1. LAUREN WESTAFER, DO, MPH
CAUTION:
CONTAINS GAS
Photo:Douglas Porter
Unpacking the Black Box of Gut
Ultrasound

2. Photo:Craig Sunter

3. Small Bowel Obstruction Ultrasound
Dilated bowel >2.5 cm
Abnormal peristalsis
Assess for:
Rub the curvilinear
probe over the abdomen
Photo:Craig Sunter
Unpacking the Black Box of Gut
Ultrasound:

4. History
Physical exam
Diagnosis of SBO
Unreliable for
X-ray

5. CT SCAN = TIME

6. Training
10 minutes
5-10 scans
Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011
Aug;28(8):676-8

7. Scanning Time
< 5 minutes

8. “Mow the lawn”
Assess paracolic gutters, quadrants

9. Dilated Bowel
Abnormal Peristalsis

10. Dilated Bowel
> 2.5 CM

11. Abnormal Peristalsis

12. Photo: Josh Semans
Piano key sign
Plicae circulares

13. Normal SBO

14. +LR 9.55
-LR 0.04
Taylor MR, Lalani N.Adult small bowel obstruction.Acad Emerg Med. 2013;20(6):528–44. doi:10.1111/acem.12150.

15. US
X-RAY
+LR 1.55
-LR 0.59
+LR 9.55
-LR 0.04
Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011;28(8):676–8. doi:10.1136/emj.2010.095729.

16. SENSITIVITY
0 0.2 0.4 0.6 0.8 1.0
CT
POCUS
XRAY
Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):528–44. doi:10.1111/
acem.12150.

17. X-RAY 27 (36%)
US 0 (0%)
Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011;28(8):676–8. doi:10.1136/emj.2010.095729.
Katz DS, Baker ME, Rosen MP, Lalani T, Carucci LR, Cash BD, Kim DH, Piorkowski RJ, Small WC, Smith MP, Yaghmai V, Yee J, Expert Panel on Gastrointestinal Imaging. ACR Appropriateness
Criteria® suspected small-bowel obstruction. [online publication]. Reston (VA): American College of Radiology (ACR); 2013.
Hedging

18. Ileus vs SBO
Transition Point
Cause
Caution:

19. I NEED THE
CT SCAN
Maung AA, Johnson DC, Piper GL et al. Evaluation and Management of Small-Bowel Obstruction. J Trauma. 73(5):S362-S369, November 2012

20. ? SBO

21. SBO

22. Ileus + edema

23. Ascites + Tumor

24. Free Air

25. SMALL BOWEL OBSTRUCTION
ULTRASOUND
Dilated bowel >2.5 cm
Abnormal peristalsis

26. +

27. References:
1. Carpenter CR, Pines JM. The end of X-rays for suspected small bowel
obstruction? Using evidence-based diagnostics to inform best practices in
emergency medicine. Acad. Emerg. Med. 2013;20(6):618–20.
2. Vicario SJ, Price TG. "Bowel Obstruction and Volvulus." Tintinalli's
Emergency Medicine: A Comprehensive Study Guide. 7th ed. pp 581-583.
3. Torrey SP, Henneman PL. "Disorders of the Small Intestine." Rosen's
Emergency Medicine. pp 1184-86.
4. Taylor MR, Lalani N. Adult small bowel obstruction. Acad. Emerg. Med.
2013;20(6):528–44.
5. Böhner H, Yang Q, Franke C, Verreet PR, Ohmann C. Simple data from
history and physical examination help to exclude bowel obstruction and to
avoid radiographic studies in patients with acute abdominal pain. Eur. J.
Surg. 1998;164(10):777–84.
6. Maung AA, Johnson DC, Piper GL et al. Evaluation and Management of
Small-Bowel Obstruction. J Trauma. 73(5):S362-S369, November 2012
7. Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection
of small bowel obstruction in the emergency department. Emerg Med J.
2011 Aug;28(8):676-8.
8. Guttman J, Stone MB, Kimberly HH, Rempell JS. Point-of-care
ultrasonography for the diagnosis of small bowel obstruction in the
emergency department.CJEM. 2014 Aug 1;16(0):30-3.

28. Photo: Josh Semans
Piano key sign
Plicae circulares
Dilated bowel
> 2.5 cm