SBO: Dilated loops of bowel with ‘too-and-fro’ peristalsis.
SBO: The above bowel diameter is 3.49 cm, greater than the 2.5cm diameter needed to diagnose an SBO.
An elderly patient presents to the ED by ambulance for respiratory distress. The team had received prehospital notification and was waiting in the resuscitation bay.
The cardio-thoracic physical exam, electrocardiogram, and POCUS were reassuring, but the abdomen was distended. On first look with the curvilinear transducer in the left lower quadrant, Dr. Lulevitch captures diagnostic images of a small bowel obstruction, dilated loops of bowel (>25mm in diameter) with 'back-and-forth’ peristalsis. The patient was visibly dyspneic, complaining of shortness of breath, so a nasogastric tube was placed resulting in 2-3 liters of output and improvement in respiratory symptoms.
Pearls: Mean time to diagnosis of SBO was 11 mins by POCUS vs. 3 hours and 42 minutes by CT scan (Boniface et al).