ABCD-EF: Sonographic Approach To Intestinal Obstruction.

Hadiel Kaiyasah Facs, Mrcs (Glasgow), Cabgs Specialist General Surgeon Rashid Hospital, Dubai, Uae


We report a case of a 35-year-old male, who presented to Accident and emergency department with three days history of abdominal pain & vomiting. He underwent open appendectomy three years ago.


Although the abdominal X-ray films (supine & erect) didn’t show features of bowel obstruction, the patient was admitted under surgical care as a case of acute adhesive small bowel obstruction, based on the clinical & sonographic assessments.

Bowel rest & fluids replacement were initiated. Over a few days, patient improved, bowel opened & he was started gradually on diet.

Intestinal obstruction (IO) is a common cause of acute abdominal pain. The recent increased use of sonography in the initial evaluation of abdominal pain has made point-of-care ultrasound a valuable tool for the diagnosis of IO.

Sonography is as sensitive, but more specific, than plain abdominal X-ray in the diagnosis of IO. Point-of-care ultrasound can answer specific questions related to IO that assist the acute care physician in critical decision making. 1

We thought of creating a simplified approach in scanning patients with suspected bowel obstruction. It is called the ABCD-EF approach.

  • A -> Activity (ileus vs. mechanical).
  • B -> Bowel thickness >3mm
  • C -> Colour Doppler (absent in ischemic segment).
  • D -> Diameter > 3cm
  • EF-> Extra-intestinal Fluid (indicating possible strangulation or perforation.)

This approach aims at looking into the main sonographic points to diagnose bowel obstruction. In the same time, it helps to differentiate simple cases from the strangulated ones. Hence providing immediate surgical intervention whenever indicated.

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