Predictive value of signs and symptoms for small bowel obstruction in patients with prior surgery.

BACKGROUND: The aim of this study was to determine the predictive value of various signs and symptoms for small bowel obstruction (SBO) in patients with prior abdominal surgery. METHODS: This was a secondary analysis of a previously reported prospective study of ultrasonography for SBO. Patients with prior abdominal surgery were identified and presenting signs and symptoms were compared to the CT diagnosis of SBO. RESULTS: No signs or symptoms were predictive of SBO. CONCLUSION: No constellation of signs and symptoms can be used to reliably exclude a SBO in patients with prior abdominal surgery.

Warfarin Overdose in a Breast-feeding Woman.

We describe a case of a breastfeeding woman with an accidental warfarin overdose resulting in a markedly elevated prothrombin time. The breast-fed infant was evaluated and tested for ill effects. We discuss the use of warfarin while breast-feeding.

Bedside ultrasonography for the detection of small bowel obstruction in the emergency department.

BACKGROUND: Plain film radiography (x-ray) is often the initial study in patients with suspected small bowel obstruction (SBO) to expedite patient care. OBJECTIVE: To compare bedside ultrasonography (US) and x-ray for the detection of SBO. METHODS: This was a prospective study using a convenience sample of patients presenting to the emergency department (ED) with abdominal pain, vomiting, or other symptoms suggestive of a SBO. Patients were evaluated with US prior to x-ray and CT. US was performed by emergency physicians (EPs) who completed a 10 min training module and five prior US exams for SBO. The criterion standard for the diagnosis of SBO was the results of CT read by board-certified radiologists. RESULTS: In all, 76 patients were enrolled and evaluated with US for SBO. A total of 33 (43%) were diagnosed as having SBO. Dilated bowel on US had a sensitivity of 91% (95% CI 75 to 98%) and specificity of 84% (95% CI 69 to 93%) for SBO, compared to 27% (95% CI 14 to 46%) and 98% (95% CI 86 to 100%) for decreased bowel peristalsis on US. X-ray had a sensitivity of 46.2% (95% CI 20.4 to 73.9%) and specificity of 66.7% (95% CI 48.9 to 80.9%) for SBO when diagnostic, but was non-diagnostic 36% of the time. CONCLUSION: EP-performed US compares favourably to x-ray in the diagnosis of SBO.