Recommended by Dr LEI Choi Chu Asta; Seconded to Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong, from Centro Hospitalar Conde de São Januário, Macau (澳門仁伯爵綜合醫院(山頂醫院)), on 9 May 2009 

Hans Peter Ledermann1, Norbert Börner2, Holger Strunk3, Georg Bongartz1, Christoph Zollikofer4 and Gerd Stuckmann4; AJR 2000; 174:107-115

The potential value of transabdominal sonography in the diagnosis of bowel diseases is often not sufficiently appreciated and is even underestimated. Bowel gas artifacts and the somewhat confusing sonographic appearance of the gastrointestinal tract may render orientation and interpretation of sonographic structures difficult. Bowel wall thickening, the main sonographic correlate of bowel disorders, seems at first glance a very nonspecific sign, which may explain why inexperienced investigators do not feel confident in the sonographic evaluation of the gastrointestinal tract. However, it has been shown that transabdominal sonography achieves good to excellent results as a directed tool for evaluating potential bowel disorders: appendicitis can be diagnosed with a sensitivity ranging from 80% to 93% and a specificity between 94% and 100% [1, 2].

Reported sensitivity rates for evaluating inflammatory bowel disease range between 67% and 96%, with specificities of 79-97% [3, 4]. Equal diagnostic accuracy of 84% was found for CT and for sonography in the workup of diverticulitis, with sensitivities of 91% and 85%, respectively, and specificities of 84% and 77%, respectively [5]. Although the sonographic appearance of bowel wall thickening of different diseases sometimes overlaps, careful examination of the thickened bowel segment in context with the clinical information often leads to a limited differential diagnosis or to the correct diagnosis.

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