Emergency Ultrasound: Hypoechoic Submucosa as Sign of Active Bowel Inflammation - Case Report

Ultrasound is a radiological examination method that is often used in daily practice for the diagnosis of various abdominal conditions that can be very complex. Very often, patients present for an examination with non-specific abdominal pain accompanied by discrete changes in the stool, which can lead to diagnostic confusion in the case of a normal ultrasound finding in the abdomen. Many radiologists have minimal experience with bowel ultrasound outside of basic indications such as appendicitis and intususception and may be uncomfortable interpreting images for other diagnosis. In our paper, we present a case of ileitis in which the diagnosis was established by ultrasound findings of hypoechoic submucosa of the terminal ileum segment along the mesenteric edge. Submucosal hypoechogenicity of the ileum can be the only sign of primary inflammation of the ileum, but also a secondary ultrasound sign of appendicitis, while in our case hypoechogenicity of the submucosa was present only on the mesenteric side of the ileum, which enabled the initial diagnosis of ileitis and the initiation of conservative therapy. Bowel ultrasound is an important diagnostic procedure in the emergency department in cases of acute abdominal pain, which in a large percentage of cases enables the triage of these patients for surgical or medical treatment.