A 62 year old female with a history of multiple abdominal surgeries presents for abdominal pain. She states she has had increasing abdominal pain and distension over the last 2 days. Over the last 24 hours, she has noticed she has stopped passing gas and has had many episodes of bilious emesis. On exam, her vitals are benign except for mild tachcycardia to 105. She has diffuse abdominal tenderness to palpation and marked abdominal distension. You are concerned for bowel obstruction.  

You perform bedside ultrasound: 

At the top of the image, you can see dilated loops of bowel. However look closely below them at the next layer of bowel. If you watch how the contents move throughout the bowel, they sway back and forth. This is called “to and fro” movement and can be a sign of bowel obstruction. 

This ultrasound image also shows dilated loops of bowel. The arrow on this ultrasound shows interloop fluid which is another sign of bowel obstruction.

This video shows the “to and fro” movement in the intestines again. 

CT was obtained:

CT showed dilated loops of bowel with air fluid levels confirming the diagnosis of SBO. Surgery was consulted and the patient was admitted for further care. 

Take Home Points:

Signs of bowel obstruction on ultrasound:

1. Dilated loops of bowel (> 2.5cm)
2. Interloop fluid
3. To-and-Fro movement of the bowel contents

Author:
Timothy Beau Stokes, MD