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.