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Point-of-Care Ultrasound in the Diagnosis of Acute Abdominal Pain

  • Francesca Cortellaro
  • Cristiano Perani
  • Linda Guarnieri
  • Laura Ferrari
  • Michela Cazzaniga
  • Giovanni Maconi
  • Maddalena Alessandra Wu
  • Paolo Aseni
Chapter
  • 837 Downloads

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.

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References

  1. 1.
    McCaig LG, Stussamm BJ. National Hospital Ambulatory Medical Care Survey: 1996 Emergency Department Summary. Adv Data. 1997; (293):1–20.Google Scholar
  2. 2.
    Tintinalli JE. Emergency medicine. New York: McGraw-Hill Education; 2016.Google Scholar
  3. 3.
    Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008;77:971–8. ReviewPubMedGoogle Scholar
  4. 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. 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.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Laurell H, Hansson LE, Gunnarsson U. Diagnostic pitfalls and accuracy of diagnosis in acute abdominal pain. Scand J Gastroenterol. 2006;41:1126–35.PubMedGoogle Scholar
  7. 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.PubMedGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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. 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. ReviewPubMedGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 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.PubMedGoogle Scholar
  13. 13.
    Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet. 2005;365:1577–89.PubMedGoogle Scholar
  14. 14.
    Thompson MM. Controlling the expansion of abdominal aortic aneurysms. Br J Surg. 2003;98:897–8.Google Scholar
  15. 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.Google Scholar
  16. 16.
    Norman PE, Powell JT. Abdominal aortic aneurysm: the prognosis in women is worse than in men. Circulation. 2007;115:2865–9.PubMedGoogle Scholar
  17. 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. 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.PubMedGoogle Scholar
  19. 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. 20.
    Kiell CS, Ernst CB. Advances in management of abdominal aortic aneurysm. Adv Surg. 1993;26:73–98.PubMedGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 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.PubMedGoogle Scholar
  23. 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.PubMedGoogle Scholar
  24. 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.PubMedGoogle Scholar
  25. 25.
    Johnson CD. ABC of the upper gastrointestinal tract. Upper abdominal pain: gall bladder. BMJ. 2001;323(7322):1170–3.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Grimpen F, Pavli P. Rational investigation of upper abdominal pain. Aust Fam Physician. 2008;37(8):602–7.PubMedGoogle Scholar
  27. 27.
    Rubens DJ. Ultrasound imaging of the biliary tract. Ultrasound Clin. 2007;2:391–413.Google Scholar
  28. 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.Google Scholar
  29. 29.
    Steven M, Strasberg MD. Acute calculous cholecystitis. N Engl J Med. 2008;358:2804–11.Google Scholar
  30. 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.PubMedGoogle Scholar
  31. 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. 32.
    Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis. JAMA. 2009;289:80–6.Google Scholar
  33. 33.
    Harvey RT, Miller WT Jr. Acute biliary disease. Radiology. 1999;213:831–6.PubMedGoogle Scholar
  34. 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.PubMedGoogle Scholar
  35. 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.PubMedGoogle Scholar
  36. 36.
    Van Breda Vriesman AC, Engelbrecht MR, Smithuis RH, Puylaert JB. Diffuse gallbladder wall thickening: differential diagnosis. Am J Roentgenol. 2007;188:495–501.Google Scholar
  37. 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.PubMedGoogle Scholar
  38. 38.
    Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, et al. WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11:25.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Larson SD, Nealon WH, Evers BM. Management of gallstone pancreatitis. Adv Surg. 2006;40:265–84.PubMedGoogle Scholar
  40. 40.
    Vilgrain V, Palazzo L. Choledocholithiasis: role of US and endoscopic ultrasound. Abdom Imaging. 2001;26:7–14.PubMedGoogle Scholar
  41. 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.PubMedGoogle Scholar
  42. 42.
    Șurlin V, Săftoiu A, Dumitrescu D. Imaging tests for accurate diagnosis of acute biliary Pancreatitis. World J Gastroenterol. 2014;20(44):16544–9.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Koo BC, Chinogureyi A, Shaw AS. Imaging acute pancreatitis. Br J Radiol. 2010;83(986):104–12.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Barrett ML, Hines AL, Andrews RM. Trends in rates of perforated appendix, 2001–2010. HCUP Statistical Brief #159. July 2013.Google Scholar
  45. 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. 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. 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.PubMedGoogle Scholar
  48. 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.PubMedGoogle Scholar
  49. 49.
    Ohle R, et al. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.PubMedPubMedCentralGoogle Scholar
  50. 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.PubMedGoogle Scholar
  51. 51.
    Atema JJ, et al. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979–90.PubMedGoogle Scholar
  52. 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.PubMedGoogle Scholar
  53. 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.PubMedGoogle Scholar
  54. 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.PubMedGoogle Scholar
  55. 55.
    Chesbrough RM, et al. Self-localization in US of appendicitis: an addition to grades compression. Radiology. 1993;187:349–51.PubMedGoogle Scholar
  56. 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.Google Scholar
  57. 57.
    Saverio D, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11:34.PubMedPubMedCentralGoogle Scholar
  58. 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.Google Scholar
  59. 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.PubMedGoogle Scholar
  60. 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.PubMedGoogle Scholar
  61. 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.PubMedGoogle Scholar
  62. 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.Google Scholar
  63. 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. 64.
    Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007;357:2057–66. ReviewPubMedGoogle Scholar
  65. 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.PubMedGoogle Scholar
  66. 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. 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.PubMedGoogle Scholar
  68. 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.PubMedPubMedCentralGoogle Scholar
  69. 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. ReviewGoogle Scholar
  70. 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.Google Scholar
  71. 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, 264:306PubMedPubMedCentralGoogle Scholar
  72. 72.
    Andeweg CS, et al. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol. 2014;49:775–84.PubMedGoogle Scholar
  73. 73.
    Baker JB, et al. Diagnosis of diverticulitis by bedside ultrasound in the Emergency department. J Emerg Med. 2006;30(3):327–9.PubMedGoogle Scholar
  74. 74.
    Helou N, et al. Sonography: first-line modality in the diagnosis of acute colonic diverticulitis? J Ultrasound Med. 2013;32:1689–94.PubMedGoogle Scholar
  75. 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.Google Scholar
  76. 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.PubMedPubMedCentralGoogle Scholar
  77. 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.PubMedGoogle Scholar
  78. 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. ReviewPubMedGoogle Scholar
  79. 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.PubMedGoogle Scholar
  80. 80.
    Mazzei MA, et al. Sigmoid diverticulitis: US findings. Crit Ultrasound J. 2013;5:S1/S5.Google Scholar
  81. 81.
    Liljegren G, Chabok A, Wickbom M, et al. Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Color Dis. 2007;9:480–8.Google Scholar
  82. 82.
    Patak MA, Mortele KJ, Ros PR. Multidetector row CT of the small bowel. Radiol Clin N Am. 2005;43:1063–77.PubMedGoogle Scholar
  83. 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.PubMedGoogle Scholar
  84. 84.
    Muradali D, Goldberg DR. US of gastrointestinal tract disease. Radiographics. 2015;35(1):50–68.PubMedGoogle Scholar
  85. 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.PubMedGoogle Scholar
  86. 86.
    Maconi G, Porro GB. Ultrasound of the gastrointestinal tract. Berlin: Springer; 2007. p. 27–34.Google Scholar
  87. 87.
    Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: what to look for. Radiographics. 2009;29:423–39.PubMedGoogle Scholar
  88. 88.
    Scheible W, Goldberger LE. Diagnosis of small bowel obstruction: the contribution of diagnostic ultrasound. AJR Am J Roentgenol. 1979;133:685–8.PubMedGoogle Scholar
  89. 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.PubMedGoogle Scholar
  90. 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.PubMedGoogle Scholar
  91. 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. 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.PubMedGoogle Scholar
  93. 93.
    Taylor M. Adult small bowel obstruction. Acad Emerg Med. 2013;20:528–44.PubMedGoogle Scholar
  94. 94.
    Jae Hoon Lim. Ultrasound examination of gastrointestinal tract disease. J Korean Med Sci. 2000;15:371–9.Google Scholar
  95. 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.PubMedGoogle Scholar
  96. 96.
    Ogata M, Mateer JR, Condon RE. Prospective evaluation of abdominal sonography for the diagnosis of bowel obstruction. Ann Surg. 1996;223:237–41.PubMedPubMedCentralGoogle Scholar
  97. 97.
    Ko YT, Lim JH, Lee DH, Lee HW, Lim JW. Small bowel obstruction: sonographic evaluation. Radiology. 1993;188(3):649–53.PubMedGoogle Scholar
  98. 98.
    Akbulut S. Intussusception due to inflammatory fibroid polyp: a case report and comprehensive literature review. World J Gastroenterol. 2012;18:5745–52.PubMedPubMedCentralGoogle Scholar
  99. 99.
    Marinis A, Yiallourou A, Samanides L, et al. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009;15:407–11.PubMedPubMedCentralGoogle Scholar
  100. 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.PubMedGoogle Scholar
  101. 101.
    Weissberg DL, Scheible W, Leopold GR. Ultrasonographic appearance of adult intussusception. Radiology. 1977;124:791–2.PubMedGoogle Scholar
  102. 102.
    Boyle MJ, Arkell LJ, Williams JT. Ultrasonic diagnosis of adult intussusception. Am J Gastroenterol. 1993;88:617–8.PubMedGoogle Scholar
  103. 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.PubMedGoogle Scholar
  104. 104.
    Jain N, Goyal N, Mukherjee K, Kamath S. Ultrasound of the abdominal wall: what lies beneath? Clin Radiol. 2013;68:85–93.PubMedGoogle Scholar
  105. 105.
    Lim JH. Ultrasound examination of gastrointestinal tract diseases. J Korean Med Sci. 2000;15:371–9.PubMedPubMedCentralGoogle Scholar
  106. 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. 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. 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.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Ko YT, Lim JH, Lee DH, Yoon Y. Small bowel phytobezoars: sonographic detection. Abdom Imaging. 1993;18:271–3.PubMedGoogle Scholar
  110. 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.PubMedGoogle Scholar
  111. 111.
    Lee DH, Lim JH, Ko YT. Afferent loop syndrome: sonographic findings in seven cases. AJR Am J Roentgenol. 1991;157:41–3.PubMedGoogle Scholar
  112. 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.PubMedGoogle Scholar
  113. 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.PubMedGoogle Scholar
  114. 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.PubMedGoogle Scholar
  115. 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.PubMedPubMedCentralGoogle Scholar
  116. 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.PubMedGoogle Scholar
  117. 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.PubMedPubMedCentralGoogle Scholar
  118. 118.
    Dietrich CF, Jedrzejczyk M, Ignee A. Sonographic assessment of splanchnic arteries and the bowel wall. Eur J Radiol. 2007;64:202–12.PubMedGoogle Scholar
  119. 119.
    Gebel M. Ultrasound in gastroenterology and hepatology. Berlin: Blackwell; 1999. p. 159–230.Google Scholar
  120. 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.PubMedPubMedCentralGoogle Scholar
  121. 121.
    Seitz K, Reising KD. Ultrasound detection of free air in the abdominal cavity. Ultraschall Med. 1982;3:4–6.PubMedGoogle Scholar
  122. 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.Google Scholar
  123. 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.PubMedGoogle Scholar
  124. 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 42PubMedGoogle Scholar
  125. 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.Google Scholar
  126. 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.PubMedPubMedCentralGoogle Scholar
  127. 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.PubMedGoogle Scholar
  128. 128.
    Mazzei MA, et al. The role of US examination in the management of acute abdomen. Crit Ultrasound J. 2013;5(Suppl 1):S6.PubMedPubMedCentralGoogle Scholar
  129. 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.Google Scholar
  130. 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.PubMedGoogle Scholar
  131. 131.
    Marks WM, Filly RA, Callen PW, Laing FC. The decidual cast of ectopic pregnancy: a confusing ultrasonographic appearance. Radiology. 1979;133:451–4.PubMedGoogle Scholar
  132. 132.
    Benson CB, Doubilet PM, Peters HE, Frates MC. Intrauterine fluid with ectopic pregnancy: a reappraisal. J Ultrasound Med. 2013;32:389–93.PubMedGoogle Scholar
  133. 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. 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.PubMedGoogle Scholar
  135. 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.PubMedGoogle Scholar
  136. 136.
    Dialani V, Levine D. Ectopic pregnancy: a review. Ultrasound Q. 2004;20(3):105.PubMedGoogle Scholar
  137. 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.PubMedGoogle Scholar
  138. 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.PubMedGoogle Scholar
  139. 139.
    Sohoni A, Bosley J, Miss JC. Bedside ultrasonography for obstetric and gynecologic emergencies. Crit Care Clin. 2014;30:207–26.PubMedGoogle Scholar
  140. 140.
    Jain KA. Sonographic spectrum of hemorrhagic ovarian cysts. J Ultrasound Med. 2002;21:v879–86.Google Scholar
  141. 141.
    Amirbekian S, Hooley RJ. Ultrasound evaluation of pelvic pain. Radiol Clin N Am. 2014;52(6):1215–35.PubMedGoogle Scholar
  142. 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.PubMedGoogle Scholar
  143. 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.PubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Francesca Cortellaro
    • 1
  • Cristiano Perani
    • 2
  • Linda Guarnieri
    • 3
  • Laura Ferrari
    • 3
  • Michela Cazzaniga
    • 3
  • Giovanni Maconi
    • 4
  • Maddalena Alessandra Wu
    • 5
  • Paolo Aseni
    • 3
  1. 1.ASST Santi Paolo e CarloMilanItaly
  2. 2.ASST degli Spedali Civili di BresciaBresciaItaly
  3. 3.ASST Dipartimento di Emergenza-UrgenzaASST Grande Ospedale Metropolitano NiguardaMilanItaly
  4. 4.Gastroenterology Unit, Department of Biomedical and Clinical Sciences, Luigi Sacco University HospitalUniversity of MilanMilanItaly
  5. 5.Department of Biomedical and Clinical Sciences “Luigi Sacco”University of Milan, ASST Fatebenefratelli Sacco, Luigi Sacco HospitalMilanItaly

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