Utilizing POCUS in the Diagnosis of Small Bowel Obstruction and the Barriers to Its Implementation in Resource-Limited Settings: A Systematic Review

Abstract

PurposeSmall bowel obstruction (SBO) is a common surgical emergency that can lead to significant morbidity, mortality, and healthcare costs, particularly when diagnosis is delayed. In rural and resource-limited emergency settings, advanced imaging techniques like computed tomography (CT) may not be readily available. As a result, clinicians often rely on physical examinations and plain radiographs which can be unreliable. Point-of-care ultrasound (POCUS) provides a rapid, radiation-free and cost-effective diagnostic alternative that can be performed directly at the bedside.MethodsWe conducted a systematic review of published literature evaluating the diagnostic accuracy and clinical utility of POCUS in identifying SBO on the following databases PubMed, Web of Science, Cochrane Library and Google Scholar databases from January 2000 to December 2024. Studies were screened and selected based on the inclusion and exclusion criteria adhering to PRISMA 2020 guidelines.ResultsThe sensitivity of POCUS for SBO ranged from 85.0 to 100%, while specificity ranged from 54.0 to 100%. Diagnostic accuracy remained high across a broad range of expertise overcoming operator dependence. Examination durations are approximately 10-11 min, which is markedly shorter than 45-min to 3-h by CT.ConclusionPOCUS presents as a practical, scalable and cost-saving tool for diagnosing SBO in rural emergency care, addressing significant gaps where CT is not available and also facilitates faster diagnosis by timely identification of specific features. Future efforts should focus on developing validated algorithms for resource-limited settings allowing immediate care management.