Diagnostic accuracy of point of care Ultrasound for detecting small bowel obstruction in Emergency Department A Prospective Observational study

Small bowel obstruction is a common and potentially life-threatening surgical emergency frequently encountered in the emergency department. Patients often present with colicky abdominal pain, vomiting, abdominal distension, and failure to pass flatus or feces. The most common etiologies of SBO differ by region, however ,intra abdominal adhesions following prior surgery remain the leading cause in developed countries, as per both sources .Other causes include hernias, neoplasms, Crohn’s disease, volvulus, and intussusception .In recent years, point-of-care ultrasonography (POCUS) has emerged as a valuable, non-invasive, bedside tool in the emergency setting. The approach is novel in it broad age range and focus on patients with clinical features of small bowel obstruction with bed side ultrasound abdominal examination and comparing with computed tomography reports. Studies have shown that with appropriate training, emergency physicians can effectively use bedside USG to detect signs of SBO, such as dilated bowel loops, abnormal peristalsis, and transition points .Key Ultrasound Features for Diagnosing SBO includes Dilated Small Bowel Loops: Diameter >2.5 cm, Altered Peristalsis: Hyperperistalsis in early stages as the bowel attempts to overcome the blockage. Hypoperistalsis or absent peristalsis in late or ischemic stages, Identification of the Transition Point :Crucial for determining the exact site of obstruction, Bowel Wall thickness >3 mm, Presence of Free Fluid: Anechoic fluid around bowel loops or in the abdomen, Whirl sign: Suggests volvulus or twisted mesentery. Target sign: May indicate intussusception. In this study, the aim is to investigate the diagnostic accuracy of pocus for detecting small bowel obstruction in emergency department patients compared to x ray and Computed Tomography findings .By examining these, we seek to understand whether point of care ultrasound can use non-invasive tool for rapid assessment of small bowel obstruction in Emergency department .X ray ABDOMEN Findings includes Dilated small bowel loops : More than 3 cm in diameter, Air-fluid levels:. Multiple levels with a "step-ladder" appearance, Paucity of gas in the colon and rectum :Suggests distal obstruction, "String of beads" sign: Small pockets of air trapped between valvulae conniventes in a fluid-filled bowel loop .Seen best on supine films, Valvulae conniventes :Thin, closely spaced mucosal folds that traverse the full width of the bowel .CT ABDOMEN FINDINGS includes Dilated small bowel loops Diameter >2.5–3 cm, Collapsed distal bowel and colon, Transition point :The area where dilated bowel suddenly becomes collapsed, "Small bowel feces sign "Mottled gas and particulate matter in the lumen, suggesting stasis of contents ,Air-fluid levels, Strangulation or ischemia indicators :Bowel wall thickening (>3 mm), Closed-loop obstruction: U-shaped or C-shaped loop of dilated bowel. "Whirl sign" of twisted mesentery.