Clinical Scenario A 70 yo woman is brought to the ED by ambulance. She’s suffering from vomit, lach of flatus and abdominal pain since 24 hours says the nurse. She’s pale, the abdomen shows a midline scar. There is diffused tenderness with rebound. Abdomen US and X rays show abnormal distended loop of small bowel. Ok, Ok I saw the images, there’s an occlusion says the surgeon at phone but, you know, I need a CT! Are there CT findings that identify patients requiring a run to the operation room? Conclusion Fortunately more than half of patients who present with SBO, resolves with non operative therapy. But on the other hand, more than 50% of bowel obstructions with ischemia are misdiagnosed. When all 3 Zielinski's signs are present strong consideration of early operative exploration should be take into account. Source
