Should intensivist do routine abdominal ultrasound?

Area of Science:

• Tropical medicine
• Gastroenterology
• Diagnostic imaging

Background:

• Ascariasis is a prevalent roundworm infection in tropical climates, particularly affecting low socioeconomic populations.
• Small bowel dysfunction and high gastric residual volumes can complicate enteral feeding in critically ill patients.
• Identifying the underlying cause of gastrointestinal issues is crucial for effective patient management.

Observation:

• A young male polytrauma patient presented with unexplained small bowel dysfunction and high gastric residual volumes during enteral feeding.
• Clinical examination and bedside abdominal ultrasound (USG) were employed to investigate the etiology of the patient's gastrointestinal symptoms.
• The intensivist utilized various frequency probes during the USG to assess bowel motility and structure.

Findings:

• Bedside abdominal ultrasound (USG) successfully identified ascariasis (roundworm infestation) as the cause of the patient's small bowel dysfunction.
• The USG findings correlated with the clinical presentation, confirming the parasitic infection.

Implications:

• This case highlights the diagnostic value of bedside abdominal ultrasound (USG) in critical care settings for identifying parasitic infections like ascariasis.
• It supports the broader adoption of whole-body USG screening by critical care physicians for comprehensive patient workup.
• Early diagnosis and targeted treatment of ascariasis can improve outcomes for critically ill patients with gastrointestinal complications.