Point-of-Care Ultrasound in the Diagnosis of Acute Abdominal Pain
Abstract
Ultrasound performed by the emergency physician has a high degree of accuracy in most common abdominal conditions characterized by acute abdominal pain and can give real-time answers in unstable or septic patients where the choice of antibiotic therapy, and need of an early surgical operation, can be lifesaving. Point-of-care ultrasound is a real-time, often available, dynamic examination with the possibility to convey dynamic information about bowel motility and changes in position and can also depict visceral blood flow. Bedsides ultrasonography may be as accurate as CT to detect ruptured abdominal aortic aneurysms, biliary tract diseases, complications of acute pancreatitis, acute appendicitis, Crohn’s disease, bowel obstruction and perforation, and gynecological emergencies. In nonobese patients, sonography can also be useful in diverticulitis, with a high sensitivity and specificity for the primary complications. Ultrasound is well established as the first-line imaging modality for diagnosing intussusception in children, but even in the adult population, bowel sonography can be very useful. Ultrasound may also detect other frequent causes of inflammatory and intestinal obstruction and rarer causes such as volvulus, ascariasis, superior mesenteric artery syndrome, gallstone ileus, bezoars, afferent loop syndrome, foreign bodies, and Crohn’s disease. Ultrasound can also be used to identify complications of ischemic bowel disease, such as pneumatosis intestinalis, portal venous gas, and pneumoperitoneum. Point-of-care ultrasound is the first imaging tool to evaluate women with acute pelvic pain. It has good accuracy to detect or rule out gynecologic disorders and can evaluate those conditions of acute abdominal pain that may require immediate surgery such as ectopic pregnancy and hemorrhagic ovarian cysts.
References
- 1.McCaig LG, Stussamm BJ. National Hospital Ambulatory Medical Care Survey: 1996 Emergency Department Summary. Adv Data. 1997; (293):1–20.Google Scholar
- 2.Tintinalli JE. Emergency medicine. New York: McGraw-Hill Education; 2016.Google Scholar
- 3.Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008;77:971–8. ReviewPubMedGoogle Scholar
- 4.Scaglione M. Imaging features and differential diagnosis for a timely management approach. Emergency radiology of the abdomen. 1st ed. Heidelberg: Springer; 2012. p. 133–64.Google Scholar
- 5.Lameris W, van Randen A, van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ. 2009;338:b2431.PubMedPubMedCentralCrossRefGoogle Scholar
- 6.Laurell H, Hansson LE, Gunnarsson U. Diagnostic pitfalls and accuracy of diagnosis in acute abdominal pain. Scand J Gastroenterol. 2006;41:1126–35.PubMedCrossRefGoogle Scholar
- 7.Prasannan S, Zhueng TJ, Gul YA. Diagnostic value of plain abdominal radiographs in patients with acute abdominal pain. Asian J Surg. 2005;28:246–51.PubMedCrossRefGoogle Scholar
- 8.MacKersie AB, Lane MJ, Gerhardt RT, Claypool HA, Keenan S, Katz DS, et al. Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology. 2005;237:114–22.PubMedCrossRefGoogle Scholar
- 9.Gans SL, Pols MA, et al. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015;32:23–31. https://doi.org/10.1159/00037158.CrossRefPubMedGoogle Scholar
- 10.Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, Lalani T, Miller FH, Small WC, Spottswood S, Sudakoff GS, Tulchinsky M, Warshauer DM, Yee J, Coley BD. ACR Appropriateness Criteria® right lower quadrant pain–suspected appendicitis. J Am Coll Radiol. 2011;8:749–55. ReviewPubMedCrossRefGoogle Scholar
- 11.Cortellaro F, Ferrari L, et al. Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study. Intern Emerg Med. 2016;12(3):371–8.PubMedCrossRefGoogle Scholar
- 12.Lederle FA, Johnson GR, Wilson SE, Chute EP, Littooy FN, Bandyk D, et al. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med. 1997;126:441–9.CrossRefGoogle Scholar
- 13.Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet. 2005;365:1577–89.PubMedCrossRefGoogle Scholar
- 14.Thompson MM. Controlling the expansion of abdominal aortic aneurysms. Br J Surg. 2003;98:897–8.CrossRefGoogle Scholar
- 15.Chichester Aneurysm Screening Group. Viborg Aneurysm Screening Study, Western Australian Abdominal Aortic Aneurysm Program, Multicentre Aneurysm Screening Study. A comparative study of the prevalence of abdominal aortic aneurysms in the United Kingdom, Denmark, and Australia. J Med Screen. 2001;8:46–50.CrossRefGoogle Scholar
- 16.Norman PE, Powell JT. Abdominal aortic aneurysm: the prognosis in women is worse than in men. Circulation. 2007;115:2865–9.PubMedCrossRefGoogle Scholar
- 17.U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics. MD LCWK1. Deaths, percent of total deaths, and death rates for the 15 leading causes of death in 5-year age groups, by race and sex: United States, 2006. 2009. [10/11/09]. pp. 7–9.Google Scholar
- 18.Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WDJ, Blebea J, et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002;287:2968–72.PubMedCrossRefGoogle Scholar
- 19.Hoffman M, Avellone JC, Pleecha GR, et al. Operation for ruptured abdominal aortic aneurysm: a community-wide experience. Surgery. 1982;91:597.PubMedGoogle Scholar
- 20.Kiell CS, Ernst CB. Advances in management of abdominal aortic aneurysm. Adv Surg. 1993;26:73–98.PubMedGoogle Scholar
- 21.Lindholt JS, Vammen S, Juul S, Henneberg EW, Fasting H. The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 1999;17:472–5.PubMedCrossRefGoogle Scholar
- 22.Costantino TG, Bruno EC, Handly N, Den AJ. Accuracy of emergency medicine ultrasound in the evaluation of abdominal aortic aneurysm. J Emerg Med. 2005;29(4):455–60.PubMedCrossRefGoogle Scholar
- 23.Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW, et al. Variability in measurement of abdominal aortic aneurysms. Abdominal Aortic Aneurysm Detection and Management Veterans Administration Cooperative Study Group. J Vasc Surg. 1995;21:945–52.PubMedCrossRefGoogle Scholar
- 24.Testa A, Lauritano EC, Giannuzzi R, Pignataro G, Casagranda I, Gentiloni Silveri N. The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain. Intern Emerg Med. 2010;5(5):401–9.PubMedCrossRefGoogle Scholar
- 25.Johnson CD. ABC of the upper gastrointestinal tract. Upper abdominal pain: gall bladder. BMJ. 2001;323(7322):1170–3.PubMedPubMedCentralCrossRefGoogle Scholar
- 26.Grimpen F, Pavli P. Rational investigation of upper abdominal pain. Aust Fam Physician. 2008;37(8):602–7.PubMedGoogle Scholar
- 27.Rubens DJ. Ultrasound imaging of the biliary tract. Ultrasound Clin. 2007;2:391–413.CrossRefGoogle Scholar
- 28.Menu Y, Vuillerme M-P. Non-traumatic abdominal emergencies: Imaging and intervention in acute biliary conditions. In: Marincek B, Dondelinger RF, editors. Emergency radiology. Berlin: Springer; 2007. p. 481–91.CrossRefGoogle Scholar
- 29.Steven M, Strasberg MD. Acute calculous cholecystitis. N Engl J Med. 2008;358:2804–11.CrossRefGoogle Scholar
- 30.Shea JA, Berlin JA, Escarce JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med. 1994;154:2573–81.PubMedCrossRefGoogle Scholar
- 31.Guyatt G, Rennie D, for the Evidence-Based Medicine Working Group, American Medical Association. Users’ guides to the medical literature: a manual for evidence-based clinical practice. Chicago, IL: AMA Press; 2002.Google Scholar
- 32.Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis. JAMA. 2009;289:80–6.Google Scholar
- 33.Harvey RT, Miller WT Jr. Acute biliary disease. Radiology. 1999;213:831–6.PubMedCrossRefGoogle Scholar
- 34.Reginelli A, Pezzullo MG, Scaglione M, Scialpi M, Brunese L, Grassi R. Gastrointestinal disorders in elderly patients. Radiol Clin N Am. 2008;46(4):755–71.PubMedCrossRefGoogle Scholar
- 35.Ralls PW, Colletti PM, Lapin SA, et al. Real-time sonography in suspected acute cholecystitis: prospective evaluation of primary and secondary signs. Radiology. 1985;155:767–71.PubMedCrossRefGoogle Scholar
- 36.Van Breda Vriesman AC, Engelbrecht MR, Smithuis RH, Puylaert JB. Diffuse gallbladder wall thickening: differential diagnosis. Am J Roentgenol. 2007;188:495–501.CrossRefGoogle Scholar
- 37.Takada T, Strasberg SM, Solomkin JS, Pitt HA, et al. Tokyo Guidelines Revision Committee. TG13:Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):1–7.PubMedCrossRefGoogle Scholar
- 38.Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, et al. WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11:25.PubMedPubMedCentralCrossRefGoogle Scholar
- 39.Larson SD, Nealon WH, Evers BM. Management of gallstone pancreatitis. Adv Surg. 2006;40:265–84.PubMedCrossRefGoogle Scholar
- 40.Vilgrain V, Palazzo L. Choledocholithiasis: role of US and endoscopic ultrasound. Abdom Imaging. 2001;26:7–14.PubMedCrossRefGoogle Scholar
- 41.Neoptolemos JP, Hall AW, Finlay DF, Berry JM, CarrLocke DL, Fossard DP. The urgent diagnosis of gallstones in acute pancreatitis: a prospective study of three methods. Br J Surg. 1984;71:230–3.PubMedCrossRefGoogle Scholar
- 42.Șurlin V, Săftoiu A, Dumitrescu D. Imaging tests for accurate diagnosis of acute biliary Pancreatitis. World J Gastroenterol. 2014;20(44):16544–9.PubMedPubMedCentralCrossRefGoogle Scholar
- 43.Koo BC, Chinogureyi A, Shaw AS. Imaging acute pancreatitis. Br J Radiol. 2010;83(986):104–12.PubMedPubMedCentralCrossRefGoogle Scholar
- 44.Barrett ML, Hines AL, Andrews RM. Trends in rates of perforated appendix, 2001–2010. HCUP Statistical Brief #159. July 2013.Google Scholar
- 45.United Kingdom National Surgical Research Collaborative, Bhangu A. Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg. 2014;259(5):894–903.Google Scholar
- 46.Velanovich V, Satava R. Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg. 1992;58(4):264–9.PubMedGoogle Scholar
- 47.Kirkil C, et al. Appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain. Ulus Travma Acil Cerrahi Derg. 2013;19(1):13–9.PubMedCrossRefGoogle Scholar
- 48.Hallan S, Asberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis–a meta-analysis. Scand J Clin Lab Invest. 1997;57(5):373–80.PubMedCrossRefGoogle Scholar
- 49.Ohle R, et al. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.PubMedPubMedCentralCrossRefGoogle Scholar
- 50.Debnath J, et al. Alvarado score: is it time to develop a clinical-pathological- radiological scoring system for diagnosing acute appendicitis? Am J Emerg Med. 2015;33(6):839–40.PubMedCrossRefGoogle Scholar
- 51.Atema JJ, et al. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979–90.PubMedCrossRefGoogle Scholar
- 52.Chang ST, Jeffrey RB, Olcott EW. Three-step sequential positioning algorithm during sonographic evaluation for appendicitis increases appendiceal visualization rate and reduces CT use. AJR Am J Roentgenol. 2014;203(5):1006–12.PubMedCrossRefGoogle Scholar
- 53.Nielsen JW, et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg. 2015;50(1):144–8.PubMedCrossRefGoogle Scholar
- 54.Koseekriniramol V, et al. Abdominal wall thickness is not useful to predict appendix visualization on sonography in adult patients with suspected appendicitis. J Clin Ultrasound. 2015;43(5):269–76.PubMedCrossRefGoogle Scholar
- 55.Chesbrough RM, et al. Self-localization in US of appendicitis: an addition to grades compression. Radiology. 1993;187:349–51.PubMedCrossRefGoogle Scholar
- 56.Fields MJ, et al. Accuracy of point of care ultrasonography for diagnosing acute appendicitis: a systematic review and meta-analysis. Acad Emerg Med. 2017;24(9):1124–36.CrossRefGoogle Scholar
- 57.Saverio D, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11:34.PubMedPubMedCentralCrossRefGoogle Scholar
- 58.Maconi G, Sampietro GM, Sartani A, Bianchi Porro G. Bowel ultrasound in Crohn’s disease: surgical perspective. Int J Color Dis. 2008;23:339–47.CrossRefGoogle Scholar
- 59.Maconi G, Radice E, Greco S, Bianchi Porro G. Bowel ultrasound in Crohn’s disease. Best Pract Res Clin Gastroenterol. 2006;20:93–112.PubMedCrossRefGoogle Scholar
- 60.Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC, et al. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis. 2013;7:556–85.PubMedCrossRefGoogle Scholar
- 61.Novak K, Tanyingoh D, Petersen F, Kucharzik T, Panaccione R, Ghosh S, et al. Clinic-based point of care transabdominal ultrasound for monitoring Crohn’s disease: impact on clinical decision making. J Crohns Colitis. 2015;9:795–801.PubMedCrossRefGoogle Scholar
- 62.Panés J, Bouzas R, Chaparro M, García-Sánchez V, Gisbert JP, Martínez de Guereñu B, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Alim Pharmacol Ther. 2011;34:125–45.CrossRefGoogle Scholar
- 63.Hammond NA, Nikolaidis P, Miller FH. Left lower-quadrant pain: guidelines from the American College of Radiology appropriateness criteria. Am Fam Physician. 2010;82:766–70. ReviewPubMedGoogle Scholar
- 64.Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007;357:2057–66. ReviewPubMedCrossRefGoogle Scholar
- 65.Hollerweger A, Macheiner P, Rettenbacher T, Brunner W, Gritzmann N. Colonic diverticulitis: diagnostic value and appearance of inflamed diverticula-sonographic evaluation. Eur Radiol. 2001;11:1956–63.PubMedCrossRefGoogle Scholar
- 66.Cuccurullo V, Cioce F, Sica A, Iasiello F, Capasso R, Gatta G, Rubini G. Gastroenteric diseases in the third millennium: a rational approach to optimal imaging technique and patient selection. Recenti Prog Med. 2012;103(11):426–30.PubMedGoogle Scholar
- 67.Tack D, Bohy P, Perlot I, De Maertelaer V, Alkeilani O, Sourtzis S, Gevenois PA. Suspected acute colon diverticulitis: imaging with low-dose unenhanced multi-detector row CT. Radiology. 2005;237:189–96.PubMedCrossRefGoogle Scholar
- 68.van Randen A, Laméris W, van Es HW, van Heesewijk HP, van Ramshorst B, Ten Hove W, Bouma WH, van Leeuwen MS, van Keulen EM, Bossuyt PM, Stoker J, Boermeester MA, OPTIMA Study Group. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol. 2011;21:1535–45.PubMedPubMedCentralCrossRefGoogle Scholar
- 69.Klarenbeek BR, de Korte N, van der Peet DL, Cuesta MA. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Color Dis. 2012;27:207–14. ReviewCrossRefGoogle Scholar
- 70.Jang HJ, Lim HK, Lee SJ, Lee WJ, Kim EY, Kim SH. Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. Am J Roentgenol. 2000;174:1397–402.CrossRefGoogle Scholar
- 71.Sai VF, Velayos F, Neuhaus J, Westphalen AC. Colonoscopy after CT diagnosis of diverticulitis to exclude colon cancer: a systematic literature review. Radiology. 2012;263:383–90. Review, Erratum in: Radiology 2012, 264:306PubMedPubMedCentralCrossRefGoogle Scholar
- 72.Andeweg CS, et al. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol. 2014;49:775–84.PubMedCrossRefGoogle Scholar
- 73.Baker JB, et al. Diagnosis of diverticulitis by bedside ultrasound in the Emergency department. J Emerg Med. 2006;30(3):327–9.PubMedCrossRefGoogle Scholar
- 74.Helou N, et al. Sonography: first-line modality in the diagnosis of acute colonic diverticulitis? J Ultrasound Med. 2013;32:1689–94.PubMedCrossRefGoogle Scholar
- 75.Talabani AJ, et al. Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis. Int J Color Dis. 2017;32:41–7.CrossRefGoogle Scholar
- 76.Sartelli M, Catena F, et al. WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg. 2016;11:37.PubMedPubMedCentralCrossRefGoogle Scholar
- 77.Salem TA, Molloy RG, O’Dwyer PJ. Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease. Dis Colon Rectum. 2007;50:1460–4.PubMedCrossRefGoogle Scholar
- 78.Ambrosetti P. Acute diverticulitis of the left colon: value of the initial CT and timing of elective colectomy. J Gastrointest Surg. 2008;12:1318–20. ReviewPubMedCrossRefGoogle Scholar
- 79.Lameris W, van Randen A, et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008;18:2498–511.PubMedCrossRefGoogle Scholar
- 80.Mazzei MA, et al. Sigmoid diverticulitis: US findings. Crit Ultrasound J. 2013;5:S1/S5.CrossRefGoogle Scholar
- 81.Liljegren G, Chabok A, Wickbom M, et al. Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Color Dis. 2007;9:480–8.CrossRefGoogle Scholar
- 82.Patak MA, Mortele KJ, Ros PR. Multidetector row CT of the small bowel. Radiol Clin N Am. 2005;43:1063–77.PubMedCrossRefPubMedCentralGoogle Scholar
- 83.Unluer EE, Yavasi O, Eroglu O, Yilmaz C, Akarca FK. Ultrasonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction. Eur J Emerg Med. 2010;17:260–4.PubMedCrossRefGoogle Scholar
- 84.Muradali D, Goldberg DR. US of gastrointestinal tract disease. Radiographics. 2015;35(1):50–68.PubMedCrossRefGoogle Scholar
- 85.Ødegaard S, Nesje LB, Lærum OD, Kimmey MB. High-frequency ultrasonographic imaging of the gastrointestinal wall. Expert Rev Med Devices. 2012;9(3):263–73.PubMedCrossRefGoogle Scholar
- 86.Maconi G, Porro GB. Ultrasound of the gastrointestinal tract. Berlin: Springer; 2007. p. 27–34.CrossRefGoogle Scholar
- 87.Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: what to look for. Radiographics. 2009;29:423–39.PubMedCrossRefGoogle Scholar
- 88.Scheible W, Goldberger LE. Diagnosis of small bowel obstruction: the contribution of diagnostic ultrasound. AJR Am J Roentgenol. 1979;133:685–8.PubMedCrossRefGoogle Scholar
- 89.Guttman J, Stone MB, Kimberly HH, Rempell JS. Point-of-care ultrasonography for the diagnosis of small bowel obstruction in the emergency department. CJEM. 2015;17(2):206–9.PubMedCrossRefGoogle Scholar
- 90.Grassi R, Romano S, D’amario F, et al. The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults. Eur J Radiol. 2004;50(1):5–14.PubMedCrossRefGoogle Scholar
- 91.Wilson SR. The acute abdomen of gastrointestinal tract origin: sonographic evaluation. In: Margulis AR, Burhenne HJ, editors. Alimentary tract radiology. 5th ed. St. Louis: Mosby; 1994. p. 2099–117.Google Scholar
- 92.Jaffe T, Thompson WM. Large-bowel obstruction in the adult: classic radiographic and CT findings, etiology, and mimics. Radiology. 2015;275(3):651–63.PubMedCrossRefGoogle Scholar
- 93.Taylor M. Adult small bowel obstruction. Acad Emerg Med. 2013;20:528–44.PubMedCrossRefGoogle Scholar
- 94.Jae Hoon Lim. Ultrasound examination of gastrointestinal tract disease. J Korean Med Sci. 2000;15:371–9.CrossRefGoogle Scholar
- 95.Carpenter CR, Pines JM. The end of x-rays for suspected small bowel obstruction? Using evidence based diagnostics to inform best practices in emergency medicine. Acad Emerg Med. 2013;20:618–20.PubMedCrossRefGoogle Scholar
- 96.Ogata M, Mateer JR, Condon RE. Prospective evaluation of abdominal sonography for the diagnosis of bowel obstruction. Ann Surg. 1996;223:237–41.PubMedPubMedCentralCrossRefGoogle Scholar
- 97.Ko YT, Lim JH, Lee DH, Lee HW, Lim JW. Small bowel obstruction: sonographic evaluation. Radiology. 1993;188(3):649–53.PubMedCrossRefGoogle Scholar
- 98.Akbulut S. Intussusception due to inflammatory fibroid polyp: a case report and comprehensive literature review. World J Gastroenterol. 2012;18:5745–52.PubMedPubMedCentralCrossRefGoogle Scholar
- 99.Marinis A, Yiallourou A, Samanides L, et al. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009;15:407–11.PubMedPubMedCentralCrossRefGoogle Scholar
- 100.Rafailidis V, Phillips C, Yusuf G, Sidhu P. A case of adult intussusception with greyscale, contrast-enhanced ultrasound and computerised tomography correlation. Ultrasound. 2017;25(2):120–5.PubMedCrossRefGoogle Scholar
- 101.Weissberg DL, Scheible W, Leopold GR. Ultrasonographic appearance of adult intussusception. Radiology. 1977;124:791–2.PubMedCrossRefGoogle Scholar
- 102.Boyle MJ, Arkell LJ, Williams JT. Ultrasonic diagnosis of adult intussusception. Am J Gastroenterol. 1993;88:617–8.PubMedGoogle Scholar
- 103.Light D, Ratnasingham K, Banerjee A, Cadwallader R, Uzzaman MM, Gopinath B. The role of ultrasound scan in the diagnosis of occult inguinal hernias. Int J Surg. 2011;9(2):169–72.PubMedCrossRefGoogle Scholar
- 104.Jain N, Goyal N, Mukherjee K, Kamath S. Ultrasound of the abdominal wall: what lies beneath? Clin Radiol. 2013;68:85–93.PubMedCrossRefGoogle Scholar
- 105.Lim JH. Ultrasound examination of gastrointestinal tract diseases. J Korean Med Sci. 2000;15:371–9.PubMedPubMedCentralCrossRefGoogle Scholar
- 106.Santín-Rivero J, Núñez-García E, Aguirre-García M, Hagerman-Ruiz-Galindo G, de la Vega-González F, Moctezuma-Velasco CR. Intestinal volvulus. Case report and a literature review. Cir Cir. 2015;83(6):522–6.PubMedGoogle Scholar
- 107.Abu-Zidan FM, Hefny AF, Saadeldinn YA, El-Ashaal YI. Sonographic findings of superior mesenteric artery syndrome causing massive gastric dilatation in a young healthy girl. Singap Med J. 2010;51:e184–6.Google Scholar
- 108.Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL. Gallstone ileus, clinical presentation, diagnostic and treatment approach. World J Gastrointest Surg. 2016;8(1):65–76.PubMedPubMedCentralCrossRefGoogle Scholar
- 109.Ko YT, Lim JH, Lee DH, Yoon Y. Small bowel phytobezoars: sonographic detection. Abdom Imaging. 1993;18:271–3.PubMedCrossRefGoogle Scholar
- 110.Hosokawa T, Yamada Y, Sato Y, Tanami Y, Nanbu R, Hagiwara SI, Oguma E. Role of sonography for evaluation of gastrointestinal foreign bodies. J Ultrasound Med. 2016;35(12):2723–32.PubMedCrossRefGoogle Scholar
- 111.Lee DH, Lim JH, Ko YT. Afferent loop syndrome: sonographic findings in seven cases. AJR Am J Roentgenol. 1991;157:41–3.PubMedCrossRefGoogle Scholar
- 112.Danse E, Jamart J, Hoang P, et al. Focal bowel wall changes detected with colour Doppler ultrasound: diagnostic value in acute non-diverticular diseases of the colon. Br J Radiol. 2004;77:917–21.PubMedCrossRefGoogle Scholar
- 113.Danse EM, Van Beers BE, Jamart J, et al. Prognosis of ischemic colitis: comparison of color Doppler sonography with early clinical and laboratory findings. AJR Am J Roentgenol. 2000;175:1151–4.PubMedCrossRefGoogle Scholar
- 114.Ripolles T, Simo L, Martinez-Perez MJ, et al. Sonographic findings in ischemic colitis in 58 patients. AJR Am J Roentgenol. 2005;184:777–85.PubMedCrossRefGoogle Scholar
- 115.James V, Warier A, Lee KP, Ong GY-K. Point-of-care ultrasound identification of pneumatosis intestinalis in paediatric abdominal pain: a case report. Crit Ultrasound J. 2017;9:2.PubMedPubMedCentralCrossRefGoogle Scholar
- 116.Pan HB, Huang JS, Yang TL, Liang HL. Hepatic portal venous gas in ultrasonogram - Benign or noxious. Ultrasound Med Biol. 2007;33(8):1179–83.PubMedCrossRefGoogle Scholar
- 117.Roccarina D, Garcovich M, Ainora ME, Caracciolo G, Ponziani F, Gasbarrini A, Zocco MA. Diagnosis of bowel diseases: the role of imaging and ultrasonography. World J Gastroenterol. 2013;19(14):2144–53.PubMedPubMedCentralCrossRefGoogle Scholar
- 118.Dietrich CF, Jedrzejczyk M, Ignee A. Sonographic assessment of splanchnic arteries and the bowel wall. Eur J Radiol. 2007;64:202–12.PubMedCrossRefGoogle Scholar
- 119.Gebel M. Ultrasound in gastroenterology and hepatology. Berlin: Blackwell; 1999. p. 159–230.Google Scholar
- 120.Nazerian P, Tozzetti C, Vanni S, Bartolucci M, Gualtieri S, Trausi F, Vittorini M, Catini E, Cibinel GA, Grifoni S. Accuracy of abdominal ultrasound for the diagnosis of pneumoperitoneum in patients with acute abdominal pain: a pilot study. Crit Ultrasound J. 2015;7:15.PubMedPubMedCentralCrossRefGoogle Scholar
- 121.Seitz K, Reising KD. Ultrasound detection of free air in the abdominal cavity. Ultraschall Med. 1982;3:4–6.PubMedCrossRefPubMedCentralGoogle Scholar
- 122.Muradali D, Wilson S, Burns PN, Shapiro H, Hope-Simpson D. A specific sign of pneumoperitoneum on sonography: enhancement of the peritoneal stripe. Am J Roentgenol. 1999;173:1257–62.CrossRefGoogle Scholar
- 123.Karahan OI, Kurt A, Yikilmaz A, Kahriman G. New method for the detection of intraperitoneal free air by sonography: scissors maneuver. J Clin Ultrasound. 2004;32:381–5.PubMedCrossRefGoogle Scholar
- 124.Moriwaki Y, Sugiyama M, Toyoda H, Kosuge T, Arata S, Iwashita M, et al. Ultrasonography for the diagnosis of intraperitoneal free air in chest- abdominal- pelvic blunt trauma and critical acute abdominal pain. Arch Surg. 2009;144:137–41. discussion 42PubMedCrossRefGoogle Scholar
- 125.Numberg D, Mauch M, Spengler J, Holle A, Pannwitz H, Seitz K. Sonographical diagnosis of pneumoretroperitoneum as a result of retroperitoneal perforation. [in German. Ultraschall Med. 2007;28:612–21.CrossRefGoogle Scholar
- 126.Wilson SP, Connolly K, Lahham S, et al. Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay. World J Emerg Med. 2016;7(3):178–82.PubMedPubMedCentralCrossRefGoogle Scholar
- 127.Thamburaj R, Sivitz A. Does the use of bedside pelvic ultrasound decrease length of stay in the emergency department? Pediatr Emerg Care. 2013;29(1):67–70.PubMedCrossRefGoogle Scholar
- 128.Mazzei MA, et al. The role of US examination in the management of acute abdomen. Crit Ultrasound J. 2013;5(Suppl 1):S6.PubMedPubMedCentralCrossRefGoogle Scholar
- 129.Kameda T, Kawai F, Taniguchi N, Kobori Y. Usefulness of transabdominal ultrasonography in excluding adnexal disease. J Med Ultrason. 2016;43(1):63–70.CrossRefGoogle Scholar
- 130.Li XH, Ouyang Y, Lu GXT. value of transvaginal sonography in diagnosing heterotopic pregnancy after in-vitro fertilization with embryo transfer. Ultrasound Obstet Gynecol. 2013;41:563.PubMedCrossRefGoogle Scholar
- 131.Marks WM, Filly RA, Callen PW, Laing FC. The decidual cast of ectopic pregnancy: a confusing ultrasonographic appearance. Radiology. 1979;133:451–4.PubMedCrossRefGoogle Scholar
- 132.Benson CB, Doubilet PM, Peters HE, Frates MC. Intrauterine fluid with ectopic pregnancy: a reappraisal. J Ultrasound Med. 2013;32:389–93.PubMedCrossRefGoogle Scholar
- 133.Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ on behalf of the Royal College of Obstetricians and Gynaecologists. Diagnosis and management of ectopic pregnancy. BJOG 2016 123(13):e15-e55.Google Scholar
- 134.Nyberg DA, Hughes MP, Mack LA, Wang KY. Extrauterine findings of ectopic pregnancy of transvaginal US: importance of echogenic fluid. Radiology. 1991;178:823–6.PubMedCrossRefGoogle Scholar
- 135.Fleischer AC, Pennell RG, McKee MS, Worrell JA, Keefe B, Herbert CM, et al. Ectopic pregnancy: features at transvaginal sonography. Radiology. 1990;174:375–8.PubMedCrossRefGoogle Scholar
- 136.Dialani V, Levine D. Ectopic pregnancy: a review. Ultrasound Q. 2004;20(3):105.PubMedCrossRefGoogle Scholar
- 137.Stein JC, Wang R, Adler N, Boscardin J, Jacoby VL, Won G, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. Ann Emerg Med. 2010;56(6):674–83.PubMedCrossRefGoogle Scholar
- 138.Richardson A, Gallos I, Dobson S, Campbell BK, Coomarasamy A, Raine-Fenning N. Accuracy of first trimester ultrasound features for diagnosis of tubal ectopic pregnancy in the absence of an obvious extra-uterine embryo: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;47(1):28–37.PubMedCrossRefGoogle Scholar
- 139.Sohoni A, Bosley J, Miss JC. Bedside ultrasonography for obstetric and gynecologic emergencies. Crit Care Clin. 2014;30:207–26.PubMedCrossRefGoogle Scholar
- 140.Jain KA. Sonographic spectrum of hemorrhagic ovarian cysts. J Ultrasound Med. 2002;21:v879–86.CrossRefGoogle Scholar
- 141.Amirbekian S, Hooley RJ. Ultrasound evaluation of pelvic pain. Radiol Clin N Am. 2014;52(6):1215–35.PubMedCrossRefGoogle Scholar
- 142.Lee EJ, Kwon HC, Joo HJ, et al. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med. 1998;17(2):83–9.PubMedCrossRefGoogle Scholar
- 143.Cicardi M, Aberer W, Banerji A, et al. Classification, diagnosis, and approach to treatment for angioedema: consensus report from the Hereditary Angioedema International Working Group. Allergy. 2014;69:602–16.PubMedCrossRefGoogle Scholar