Bowel obstruction (BO) in neonates presents a diverse range of potential diagnoses, from non-urgent issues to critical surgical emergencies. While abdominal radiographs are typically the first imaging modality employed to assess bowel obstruction, ultrasound (US) can serve as a primary imaging tool for certain indications. Therefore, it is essential for radiologists to be adept at recognizing the various types of bowel obstruction that can be diagnosed using ultrasound. Key sonographic features indicative of bowel obstruction include differential dilation of bowel loops, thickening of the bowel wall, and the presence of free fluid. Critical “Do Not Miss” findings that necessitate immediate intervention include conditions such as volvulus, pneumoperitoneum, and signs of ischemia, which manifest as bowel wall thinning and/or absent perfusion.
This pictorial essay aims to provide comprehensive guidance on the ultrasound techniques and findings that facilitate the accurate identification of bowel obstruction in neonates. Through illustrative examples, the essay highlights both common and rare etiologies of neonatal bowel obstruction as visualized on ultrasound. By enhancing the understanding of ultrasound characteristics related to bowel obstruction, this resource aims to empower clinicians and radiologists to make timely and informed decisions regarding patient management. Effective ultrasound imaging can significantly improve diagnostic accuracy and ultimately influence outcomes in neonates presenting with bowel obstruction.
