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Likelihood Ratio (LR) in Emergency Medicine

2/10/2012

Bowel obstruction and physical examination

A 75 y/o man arrives in ED from a nursing. 
He complains abdominal pain. 
No fever, no jaundice, abdomen presents distended. 
Inspection shows a midline old scar,
there is diffuse rigidity, 
increased bowel sounds and vomit on the sheets. 

Can history and clinical examination contribute to diagnosis of bowel obstruction?



















Conclusion 

Medical history and physical examination are a good method in evaluation of a patient with a suspected bowel obstruction. Age > 50 years, distended abdomen, increased bowel sounds, vomit, history of costipation,  previous abdominal surgery  alone can increase the probability of bowel obstruction. The combination of three of this has a very high LR+ from 19 to infinity! Although in some case clinical examination could be diagnostic of bowel obstruction without any other investigation, the practice of plain radiography is still very diffused….what about it?


Bibliography 

H Bohner, Q Yang et al:
Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. 
Eur J Surg 1998; 164:777-784


Ciro Paolillo and Ilenia Spallino



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