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POCUS for Infectious Enteritis-A Retrospective Case Series Analysis
1From the Pediatric Emergency, Kaplan Medical Center.
Insights
Point-of-care ultrasound (POCUS) can identify right-sided bowel wall edema in children, suggesting bacterial enteritis and helping differentiate it from appendicitis. This imaging can reduce unnecessary hospital resource use.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Gastroenterology
Background:
- Abdominal pain in children often presents diagnostic challenges, particularly distinguishing diarrhea-related pain from appendicitis.
- Right-sided bowel wall edema on ultrasound can be an indicator of enteritis.
Purpose of the Study:
- To evaluate the utility of pediatric emergency department point-of-care ultrasound (POCUS) in identifying right-sided bowel wall edema.
- To assess the correlation between POCUS findings and diagnoses of enteritis versus appendicitis in children.
Main Methods:
- A retrospective case series of children with right-sided bowel wall edema identified via POCUS.
- Review of hospital charts for clinical presentation, diagnostic workup, and outcomes.
- Analysis of stool sample results for bacterial pathogens.
Main Results:
- 113 children presented with right-sided small bowel wall edema on POCUS.
- 31% were initially referred for appendicitis evaluation.
- Bacterial enteritis (Campylobacter, Salmonella, Shigella) was confirmed in a significant portion of children with stool samples.
- 40% were discharged after POCUS without further evaluation, and no cases of inflammatory bowel disease were subsequently diagnosed.
Conclusions:
- Bowel wall edema on POCUS, in the absence of appendicitis signs, strongly indicates bacterial enteritis in pediatric patients.
- Early POCUS can aid in differentiating enteritis from appendicitis, potentially reducing hospital resource utilization.
Introduction:
The abdominal pain associated with diarrhea can be difficult to distinguish from appendicitis. We present a case series of all children found on pediatric emergency department point-of-care ultrasound (POCUS) to have right-sided bowel wall edema.
Methods:
Over the study period June 2020 through September 2023, POCUS images were collected by a pediatric emergency physician with 6 years of experience with POCUS. Children found to have small bowel wall edema on POCUS were identified, and hospital charts were reviewed.
Results:
One hundred thirteen children were found on POCUS to have right-sided small bowel wall edema. Thirty-one (27%) were referred by their pediatrician or urgent care provider to evaluate for appendicitis. Seventy-eight children (69%) provided stool samples. Of those, 58% resulted Campylobacter , 8% Salmonella , and 8% Shigella . Forty (35%) were discharged after POCUS without further evaluation. One child in our case series was subsequently diagnosed with uncomplicated appendicitis. To date, no child in the series has subsequently been diagnosed with inflammatory bowel disease.
Conclusions:
Enteritis can initially be difficult to distinguish on clinical grounds from acute appendicitis. Bowel wall edema on POCUS in a child without sonographic signs of appendicitis strongly suggests bacterial enteritis. Early POCUS demonstrating enteritis without signs of appendicitis may decrease hospital resource usage.
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