ABDOMINAL ULTRASONOGRAPHY FOR THE DIAGNOSIS OF STRANGULATION IN SMALL-BOWEL OBSTRUCTION

The efficacy of abdominal ultrasonography for the recognition of stran gulation was evaluated prospectively in 231 patients with adhesive sma ll bowel obstruction. The diagnosis based on ultrasonographic criteria was accurate in 35 of 39 patients with strangulation and in 176 of 19 2 with simple obstruction. Abdominal ultrasonography revealed the pres ence of strangulation in 13 of 15 patients with strangulation who were clinically diagnosed as having simple obstruction, and ruled it out i n 28 of 36 with simple obstruction who were clinically suspected to ha ve strangulation. An akinetic dilated loop observed on real-time ultra sonography proved to have high sensitivity (90 per cent) and specifici ty (93 per cent) for the recognition of strangulation; however, its po sitive predictive value for strangulation was only 73 per cent. The pr esence of peritoneal fluid was sensitive for strangulation. Compared w ith clinical judgement based on conventional parameters, abdominal ult rasonography proved to be useful for the early recognition of strangul ation.