Utilizing POCUS to Diagnose SBO with Tanga Sign

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Bowel obstruction accounts for 15% of hospital admissions for acute abdominal pain in the United States. Among these patients, 80% are due to a small bowel obstruction (SBO). History of previous abdominal surgery is the leading cause of SBO in developed countries with 75% of cases arising as a result of post-operative adhesions. With this, risk of SBO increases with an increased number of abdominal surgeries. Patients can present with a range of symptoms, most commonly abdominal pain and inability to pass gas. The diagnosis of SBO has historically been done through the use of Computed tomography (CT) and radiograph techniques. Point-of-care ultrasound (POCUS) can also be used for diagnosis of SBO and offers several advantages over CT; it is considerably faster, less expensive, no exposure to radiation or contrast dye and can be done bedside in the Emergency Department (ED).

An 85 year-old woman with a history of numerous abdominal surgeries presented to the ED with nausea and vomiting, abdominal pain, and bloating. She also reported decreased flatulence and her last bowel movement was a few days prior. On physical examination her abdomen had diffuse tenderness to palpation with guarding and rebound. POCUS was performed by the emergency medicine provider at 10:57am, with immediate interpretation, and demonstrated dilated loops of bowel, with bidirectional peristalsis, and a positive Tanga Sign (a tanga sign is a triangular collection of free fluid between loops of bowel from transudative bowel wall edema, indicating a high grade SBO.) A CT scan was also performed on this patient but didn't result until 11:46, 49 minutes later. CT abdomen and pelvis showed small bowel dilation with air-fluid levels and obstruction.

This case underscores the utility of point-of-care ultrasound (POCUS) as a rapid, accurate, and non-radiation based modality for diagnosing small bowel obstruction (SBO) in the emergency setting. POCUS allows for bedside assessment, expediting clinical decision-making and potentially reducing the need for more time-consuming or radiation-based imaging. Notably, evidence suggests that emergency medicine residents can achieve reliable diagnostic accuracy in identifying SBO after as little as 6 hours of POCUS training, highlighting its practicality as a diagnostic tool.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1931

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