Which imaging modalities are most effective for diagnosing bowel obstruction in a primary care setting?

In a primary care setting, the most effective initial imaging modality for diagnosing bowel obstruction is abdominal ultrasound, particularly point-of-care ultrasound (POCUS). Ultrasound is non-invasive, readily available, and can identify signs of small bowel obstruction such as dilated loops and decreased peristalsis without radiation exposure, making it suitable for primary care use NICE CKS. While abdominal X-ray is traditionally used in secondary care to detect bowel obstruction, its sensitivity and specificity are limited, and it is less practical as a first-line tool in primary care. Computed tomography (CT) is the gold standard for confirming bowel obstruction and identifying its cause but is generally not accessible or appropriate for initial assessment in primary care NICE CKS.

Recent evidence from emergency department settings supports the accuracy of point-of-care ultrasound in detecting small bowel obstruction, showing high sensitivity and specificity comparable to CT scans Pourmand et al. 2018. This suggests that with appropriate training, primary care clinicians could effectively use ultrasound to triage patients suspected of bowel obstruction, facilitating timely referral and management Pourmand et al. 2018.

Therefore, integrating UK guideline recommendations with recent literature indicates that abdominal ultrasound, especially POCUS, is the most effective and practical imaging modality for diagnosing bowel obstruction in primary care, with CT reserved for secondary care confirmation and further evaluation.