A 59 y/o F presents with two days of nausea, vomiting, and worsening abdominal pain with distention. She had small, non-bloody bowel movement earlier in the day and was passing flatus. She is unable to tolerate any PO liquids or solids without vomiting in the AES. Bedside ultrasound revealed the following images / clips:
Our patient was diagnosed with a leiomyosarcoma, with a mechanical small bowel obstruction. Small bowel obstructions are a common presentation to the Emergency Department- and represent approximately 20% of all surgical admissions for acute abdominal pain. Traditional imaging includes xrays, CT, however US is emerging as a fast, reliable and reproducible method to assess for obstructive processes.
Using a low-frequency transducer, assess multiple regions of the abdomen, visualizing the bowel. Abnormalities include fluid-filled small bowel loops dilated > 2.5-3cm in size, visualization of a “to-and-fro” motion of the bowel contents within the dilated segment. Ultrasound has limitations- as it is challenging to identify a transition point or the exact etiology of the obstruction. However, using ultrasound early in a patient you suspect obstruction can aid in a more rapid diagnosis and further expedite care!