PROSPECTIVE EVALUATION OF ABDOMINAL SONOGRAPHY FOR THE DIAGNOSIS OF BOWEL OBSTRUCTION

Objective The authors determined the utility of sonography compared wi th plain x-rays in the diagnosis of bowel obstruction. In a contempora neous group of patients, they compared the cost of operative versus no noperative management of small bowel obstruction. Summary Background D ata Nonoperative treatment of simple bower obstruction usually succeed s. However, because of the difficulty in assured diagnosis and the pos sibility of strangulation or other complication, exploration of suspec ted bowel obstruction is recommended. Most of these explorations could be avoided if diagnostic accuracy were better, yielding a desirable d ecrease in the overall cost of managing bowel obstruction. Methods Fif ty patients whose clinical or plain x-ray findings suggested bowel obs truction underwent prospective evaluation by abdominal sonography and by flat and upright abdominal x-rays. Presence or absence of bower obs truction was determined at laparotomy and by clinical evolution of the abdominal episode. Direct costs of care were determined from the hosp ital and physician bills of 54 patients treated contemporaneously with the sonography study. Results Sonography demonstrated bower obstructi on by showing fluid-filled dilated bowel loops proximal to collapsed b owel in 22 patients with one false-positive and three false-negative e xaminations. X-rays demonstrated bowel obstruction in 32 patients with nine false-positive and one false-negative examination. Cost data sho wed that operative treatment of simple bower obstruction increased cos ts nearly eightfold. Conclusions Sonography is as sensitive but more s pecific than plain x-rays in the diagnosis of bower obstruction. Manag ement based on sonographic findings has the potential to reduce costs of surgical care.