Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction
Ultrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). Because the indications for and timing of surgical intervention for SBO have changed over the past several decades, there is a widespread assumption that the majority of patients with simple SBO may be conservative...
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| Format: | Article |
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MDPI AG
2020-05-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/10/5/277 |
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| author | Stefania Tamburrini Nicola Serra Marina Lugarà Giuseppe Mercogliano Carlo Liguori Gabriella Toro Francesco Somma Ylenia Mandato Maria Vittoria Guerra Giuseppe Sarti Roberto Carbone Pasquale Tammaro Andrea Ferraro Roberta Abete Ines Marano |
| author_facet | Stefania Tamburrini Nicola Serra Marina Lugarà Giuseppe Mercogliano Carlo Liguori Gabriella Toro Francesco Somma Ylenia Mandato Maria Vittoria Guerra Giuseppe Sarti Roberto Carbone Pasquale Tammaro Andrea Ferraro Roberta Abete Ines Marano |
| author_sort | Stefania Tamburrini |
| collection | DOAJ |
| description | Ultrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). Because the indications for and timing of surgical intervention for SBO have changed over the past several decades, there is a widespread assumption that the majority of patients with simple SBO may be conservatively managed; in this scenario, staging SBO is crucial. This study evaluated the association between morphological and functional US signs in the diagnosis and staging (simple, decompensated and complicated), and the associations and prevalence of US signs correlated with clinical or surgical outcome. The US signs were divided into diagnostic (dilated bowel loops and altered kinesis) and staging criteria (extraluminal free fluid, parietal and villi alterations). We performed a retrospective, single-center cohort, observational study examining the prevalence of morphologic and functional US signs in the staging of simple, decompensated and complicated SBO. The most significant US signs were dilated bowel loops (100%), hypokinesis (90.46%), thickened walls (82.54%) and free fluid (74.60%). By linear regression, free fluid was positively correlated to US staging in both univariate and multivariate analysis; that is, the more advanced the stage of SBO, the more probable the presence of free fluid between the bowel loops. In univariate analysis only, we found a positive correlation between US staging/thickened walls and the prominence of valvulae conniventes. Additionally, the multivariate analysis indicated that parietal stratification and bowel jump kinesis were negative predictors for US staging in comparison to other US signs. In addition, we found significant associations between conservative treatment or surgery and hypokinesis (<i>p</i> = 0.0326), akinesis (<i>p</i> = 0.0326), free fluid (<i>p</i> = 0.0013) and prominence of valvulae conniventes (<i>p</i> = 0.011). Free fluid in particular was significantly less present in patients that were conservatively treated (<i>p</i> = 0.040). We conclude that the US staging of SBO may be crucial, with a valuable role in the initial diagnosis and staging of the pathology, saving time and reducing total radiation exposure to the patient. |
| first_indexed | 2024-03-10T20:03:13Z |
| format | Article |
| id | doaj.art-2f51d9b4fea2482093faa1288ca9c5c6 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T20:03:13Z |
| publishDate | 2020-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-2f51d9b4fea2482093faa1288ca9c5c62023-11-19T23:25:14ZengMDPI AGDiagnostics2075-44182020-05-0110527710.3390/diagnostics10050277Ultrasound Signs in the Diagnosis and Staging of Small Bowel ObstructionStefania Tamburrini0Nicola Serra1Marina Lugarà2Giuseppe Mercogliano3Carlo Liguori4Gabriella Toro5Francesco Somma6Ylenia Mandato7Maria Vittoria Guerra8Giuseppe Sarti9Roberto Carbone10Pasquale Tammaro11Andrea Ferraro12Roberta Abete13Ines Marano14Department of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Molecular Medicine and Medical Biotechnology, University of Naples“Federico II”, 80131 Naples, ItalyDepartment of Internal Medicine, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Radiology, University of Naples “Federico II”, 80131 Naples, ItalyDepartment of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Emergency Medicine, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Surgery, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Emergency Medicine, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Surgery, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyDepartment of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, ItalyUltrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). Because the indications for and timing of surgical intervention for SBO have changed over the past several decades, there is a widespread assumption that the majority of patients with simple SBO may be conservatively managed; in this scenario, staging SBO is crucial. This study evaluated the association between morphological and functional US signs in the diagnosis and staging (simple, decompensated and complicated), and the associations and prevalence of US signs correlated with clinical or surgical outcome. The US signs were divided into diagnostic (dilated bowel loops and altered kinesis) and staging criteria (extraluminal free fluid, parietal and villi alterations). We performed a retrospective, single-center cohort, observational study examining the prevalence of morphologic and functional US signs in the staging of simple, decompensated and complicated SBO. The most significant US signs were dilated bowel loops (100%), hypokinesis (90.46%), thickened walls (82.54%) and free fluid (74.60%). By linear regression, free fluid was positively correlated to US staging in both univariate and multivariate analysis; that is, the more advanced the stage of SBO, the more probable the presence of free fluid between the bowel loops. In univariate analysis only, we found a positive correlation between US staging/thickened walls and the prominence of valvulae conniventes. Additionally, the multivariate analysis indicated that parietal stratification and bowel jump kinesis were negative predictors for US staging in comparison to other US signs. In addition, we found significant associations between conservative treatment or surgery and hypokinesis (<i>p</i> = 0.0326), akinesis (<i>p</i> = 0.0326), free fluid (<i>p</i> = 0.0013) and prominence of valvulae conniventes (<i>p</i> = 0.011). Free fluid in particular was significantly less present in patients that were conservatively treated (<i>p</i> = 0.040). We conclude that the US staging of SBO may be crucial, with a valuable role in the initial diagnosis and staging of the pathology, saving time and reducing total radiation exposure to the patient.https://www.mdpi.com/2075-4418/10/5/277bowel ultrasoundsmall bowel obstructionemergency ultrasound |
| spellingShingle | Stefania Tamburrini Nicola Serra Marina Lugarà Giuseppe Mercogliano Carlo Liguori Gabriella Toro Francesco Somma Ylenia Mandato Maria Vittoria Guerra Giuseppe Sarti Roberto Carbone Pasquale Tammaro Andrea Ferraro Roberta Abete Ines Marano Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction Diagnostics bowel ultrasound small bowel obstruction emergency ultrasound |
| title | Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction |
| title_full | Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction |
| title_fullStr | Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction |
| title_full_unstemmed | Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction |
| title_short | Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction |
| title_sort | ultrasound signs in the diagnosis and staging of small bowel obstruction |
| topic | bowel ultrasound small bowel obstruction emergency ultrasound |
| url | https://www.mdpi.com/2075-4418/10/5/277 |
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