Which imaging modalities are most effective for confirming a diagnosis of small bowel obstruction in primary care?

In primary care, the most effective imaging modality for confirming a diagnosis of small bowel obstruction (SBO) is abdominal X-ray, as it is widely accessible and can identify characteristic signs such as dilated bowel loops and air-fluid levels NICE NG147. However, abdominal X-rays have limitations in sensitivity and specificity. Point-of-care ultrasound (POCUS) is increasingly recognised as a valuable adjunct in the primary care or emergency setting for detecting SBO, offering real-time visualization of dilated bowel loops, decreased peristalsis, and free fluid, with good diagnostic accuracy Pourmand et al. 2018. While cross-sectional imaging like CT scan provides the highest diagnostic accuracy and detailed information on the cause and severity of SBO, it is generally not available in primary care and is reserved for secondary care referral NICE NG147. Therefore, the initial imaging approach in primary care should prioritise abdominal X-ray, supplemented by POCUS where available and clinicians are trained, to improve diagnostic confidence before referral Pourmand et al. 2018.