IOTW 01-01-18

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Case

  • 36 yo F presents to ED for abdominal pain. Abdominal pain is located in the RUQ and LLQ. Associated with one episode of diarrhea in the morning and emesis.
  • ED team requested a RUQ sono to assess for biliary pathology
  • During the exam, the patient asked “ Can you look here where it’s REALLY hurting?” and pointed to LLQ

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Small Bowel Obstruction On Ultrasound?

 

Criteria of SBO

  • dilated bowel loop (diameter > 2.5 cm)
  • bowel wall thickening > 3mm
  • fluid-filled distended bowel with extra luminal free fluid between bowel loops
  • Back and forth peristalsis
  • May see transition point

 

What happened to the patient:

  • Patient was found to have an SBO on CT scan. She went to the OR for an emergent ex-lap and was found to have frank pus in her abdomen without any signs of perforation.

 

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