Ultrasound detection of bowel obstruction.

Bowel obstruction is an acute alarming situation with limited diagnostic co nditions. Therapeutic decisions must be taken in time. Diagnostic different iation between incomplete or complete bowel obstruction, intestinal obstruc tion and paralytic ileus is often uncertain and the underlieing cause diffi cult to detect. Besides plain films in acute abdomen the ultrasound examina tion presents important additional informations: 1(st) Dilated intestinal l oops and gas caps correlate with the characteristic x-ray finding, i.e. ere cted dilated intestinal loops with fluid levels. The location of the obstru ction is defined in small bowel obstruction by differentiation between jeju num (with Kerckring folds) and ileum (without Kerckring folds). In large bo wer obstruction the caecum is dilated and a collapse of the distal colon is detectable. 2(nd) Additional sonographical findings are: oedema of the int estinal walls, hyperpendulum peristalsis or absence of peristalsis, sedimen tation of intestinal contents, pearlstring-like lined up gas bubbles under the ventral intestinal walls, and concomitant ascites. Duplex sonographical studies of the intestinal peristalsis may help to differentiate between me chanical obstruction and paralytic ileus. 3(nd) In bowel obstruction stenos es can be detected as a result of tumour, Crohn's disease diverticulitis, i nvagination, strangulated hernias or gall stone ileus. Intestinal adhesions cannot be found by ultrasound. Small and large bowel is dilated in paralyt ic ileus. Numerous causes like acute pancreatitis, ureteral colic, free gas trointestnal perforation and so on can be diagnosed. 4(th) In ileus of vasc ular disorder early diagnosis is high important, but inspite of colour flow imaging diagnostic possibilities are limited. 5(th) Sonographical diagnosi s is of special interest when the x-ray plain films is "empty". The lack of massive fluid collection and meteorism allows an optimal ultrasound examin ation. In this early phase disorders of peristalsis and intestinal walls ar e reliably found, and it is easier to find the cause of bowel obstruction. In this way the definitive diagnosis can be arrived at earlier, because it still takes up to 6 hours to obtain the classical x-ray finding. There is a rule that the earlier ultrasound is done, the more findings one will get.