Presentation
Asymptomatic.
Patient Data
Transabdominal ultrasonography, performed supine with the probe placed in a transverse orientation in patient's right lower quadrant.
Cine loop depicts two jejunal loops with prominent plicae circularis. Bowel wall and luminal diameter within normal limits, no free fluid. The leftmost loop demonstrates a peristaltic contraction of appropriate amplitude.
Subsequent still images depict relaxed and contracted state of the previously depicted loops.
Normal study for reference.
Case Discussion
Small bowel may be recognized by its characteristic mural stratification, with alternating concentric circles of contrasting echogenicity. The thin, echogenic serosa (variably visualized) surrounds the prominent, hypoechoic muscularis, which in turn encircles an echogenic submucosal layer 2.
In health, the small bowel wall thickness is less than 3 mm, total diameter under 2.5 cm, with regular waves of peristalsis resulting in anteropulsion of the contents within.
Wall thickening, effacement of the characteristic mural pattern, and derangement of productive peristaltic waves are features common to many small bowel pathologies that may be recognized at the point of care 1.
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