Delayed traumatic small bowel obstruction diagnosed by point-of-care ultrasound (POCUS)

Delayed small bowel obstruction is a rare complication of blunt abdominal trauma and is typically diagnosed by computed tomography (CT) imaging. A 22-year-old man initially presented to Emergency Department 12 h after a motor vehicle collision and CT imaging was unrevealing for any intra-abdominal injury. The patient returned 4 days later with new abdominal pain, vomiting, and watery stool. His exam demonstrated only suprapubic tenderness without guarding. A point-of-care ultrasound was performed by the emergency physician given recent abdominal trauma which showed dilated loop of small bowel with a "to-and-fro" sign raising the concern for small bowel obstruction. A repeat CT scan of the abdomen/pelvis confirmed the presence of small bowel obstruction with a transition point at the distal ileum caused by focal mesenteric edema. This case highlights a rare complication of blunt abdominal trauma that emergency physicians should consider in their differential diagnosis and not be misled by recent negative imaging. Additionally, the case illustrates the role of POCUS in evaluating not only intra-abdominal free fluid but also alternative traumatic abdominal pathology.