1. 01 Jan 2018 Courtesy of Madi Lindauer
IOTW
01 Jan 2018
Courtesy of Madi Lindauer

2. Case
36 yo F presents to ED for abdominal pain. Abdominal pain is located in the RUQ and LLQ. Associated with one episode of diarrhea in the morning and emesis.
ED team requested a RUQ sono to assess for biliary pathology
During the exam, the patient asked “ Can you look here where it’s REALLY hurting?” and pointed to LLQ

3. LLQ

4. Did you
Notice the
Dilated loops?
Or the thickened
Bowel wall?
Plicae
Circulares
2.89 cm
0.46 cm

5. NOTICE
THE
“TO AND
FRO”

6. Small Bowel Obstruction On Ultrasound?
Signs of?
Small Bowel Obstruction On Ultrasound?

7. Criteria of SBO dilated bowel loop (diameter > 2.5 cm)
bowel wall thickening > 3mm
fluid-filled distended bowel with extra luminal free fluid between bowel loops
Back and forth peristalsis
May see transition point

8. What happened to the patient:
Patient was found to have an SBO on CT scan. She went to the OR for an emergent ex-lap and was found to have frank pus in her abdomen without any signs of perforation.