Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies – An EFSUMB Position Paper

Abstract

An interdisciplinary group of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of three time-critical causes of acute abdomen: bowel obstruction, gastrointestinal perforation and acute ischemic bowel disease. Based on an extensive literature review, statements for a targeted diagnostic strategy in these intestinal emergencies are presented. GIUS is best established in case of small bowel obstruction. Metanalyses and prospective studies showed a sensitivity and specificity comparable to that of computed tomography (CT) and superior to plain X-ray. GIUS may save time and radiation exposure and has the advantage of displaying bowel function directly. Gastrointestinal perforation is more challenging for less experienced investigators. Although GIUS in experienced hands has a relatively high sensitivity to establish a correct diagnosis, CT is the most sensitive method in this situation. The spectrum of intestinal ischemia ranges from self-limited ischemic colitis to fatal intestinal infarction. In acute arterial mesenteric ischemia, GIUS may provide information, but prompt CT angiography is the gold standard. On the other end of the spectrum, ischemic colitis shows typical ultrasound features that allow correct diagnosis. GIUS here has a diagnostic performance similar to CT and helps to differentiate mild from severe ischemic colitis.

Zusammenfassung

Eine interdisziplinäre Arbeitsgruppe von europäischen Experten gibt einen Überblick über den Wert des gastrointestinalen Ultraschalls (GIUS) bei der Abklärung von 3 zeitkritischen Ursachen eines akuten Abdomens: Ileus, Perforation und akute Darmischämie. Basierend auf einer ausgiebigen Literaturrecherche werden Aussagen für eine zielgerichtete diagnostische Abklärung bei diesen intestinalen Notfällen präsentiert. GIUS ist eine gut etablierte Methode bei der Frage nach einem mechanischen Dünndarmverschluss. Metaanalyen und prospektive Studien haben eine mit der Computertomografie (CT) vergleichbare, gegenüber der Röntgen-Abdomen-Nativaufnahme aber bessere Sensitivität und Spezifität gezeigt. GIUS kann Zeit und Strahlungsdosis sparen und hat den Vorteil einer direkten Beurteilung der peristaltischen Aktivität. Gastrointestinale Perforationen sind eine Herausforderung für weniger erfahrene Untersucher. Obwohl GIUS in der Hand des erfahrenen Untersuchers bei dieser Diagnose eine relative hohe Sensitivität erreicht, ist die CT die sensitivste Methode. Das Spektrum der Darmischämie reicht von der selbstlimitierenden ischämischen Kolitis bis zur fatalen Darminfarzierung. Bei der akuten arteriellen Mesenterialischämie kann GIUS zwar Hinweise geben, die rasche CT-Angiografie ist aber der Goldstandard. Am anderen Ende des Spektrums ermöglichen typische Ultraschallzeichen die korrekte Diagnose der ischämischen Kolitis. GIUS ist hier vergleichbar mit der CT und hilft milde von schweren Formen zu unterscheiden.

Key words

ultrasound - ischemic bowel disease - gastrointestinal tract - bowel obstruction - perforation

Publication History

Received: 18 November 2019

Accepted: 16 March 2020

Article published online:
20 April 2020

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