Background: Small bowel obstruction (SBO) is a common cause of acute abdominal pain. Many diagnostic modalities are used to diagnose or rule out SBO. Objective: This study aimed to compare the diagnostic accuracy of SBO for point-of-care ultrasound (POCUS) to that of abdominal X-ray (AXR) using computerized tomography (CT) and/or patients’ follow-up as the gold standard. Methods: This was a prospective, cohort study of a convenience sample of adult patients, who presented to the emergency department (ED) with signs and symptoms suggestive of SBO. Emergency medicine residents performed POCUS looking for sonographic signs of SBO. Abdominal X-ray and CT results were based on the radiologist’s final report. Results: A total of 77 patients were enrolled in the study. The mean age was 56 years, and the mean BMI was 28 kg/m2. Point-of-care ultrasound had a sensitivity of 90%, specificity of 61%, +likelihood ratio (LR) of 2.3, and -LR of 0.159, compared to AXR, which had a sensitivity of 57%, specificity of 62%, +LR of 1.5, and -LR 0.69. Conclusion: POCUS performed by ED residents for the diagnosis of SBO has high diagnostic accuracy as compared to that of AXR, with a p-value of 0.046. The accuracy is higher if all the sonographic signs are present or absent.

Keywords: Point-of-care ultrasound, small bowel obstruction, emergency ultrasound, bedside ultrasound.