[Experimental use of duplex Doppler ultrasonography in the evaluation of intestinal motility in occlusive syndromes].

Intestinal motility is currently evaluated by means of clinical, radiologic and electromanometric methods. Of late, US has allowed to visualize the intestinal loops and their movements directly assessing wall patterns and endoluminal contents, as well as the degree of distension of the ileal loops; its diagnostic value is in fact well established in the study of such specific diseases of the GI tract as inflammatory conditions and neoplasms. On the contrary, the use of duplex-Doppler US to investigate bowel motility is quite new. We used duplex-Doppler US to evaluate intestinal peristalsis in 37 patients presenting with acute abdominal pain (15 patients with early mechanical obstruction; 13 patients with long-standing mechanical obstruction; 9 patients with paralytic ileus). In 29 patients the diagnosis was surgically confirmed; in 8 patients the diagnosis was established by means of other diagnostic techniques. The duplex-Doppler recordings showed typical patterns characterized by different degrees of signal intensity and frequency according to the type of obstruction (mechanical or paralytic ileus), to its duration (acute or long-standing), and to the site of Doppler sampling (proximal to or in the obstacle). As regards the correct identification of the cause of the obstruction, duplex-Doppler sensitivity and specificity were 85% and 100%, respectively. The positive predictive value was high (100%) whereas the negative predictive value was low (37.5%). Duplex-Doppler evaluation provides both qualitative and quantitative data about intestinal peristalsis, allowing true peristaltic movements to be discriminated from simple mixing movements of the bowel. The possibility to identify intestinal segments with different degrees of peristaltic activity seems very useful to detect the site of the obstacle in mechanical obstruction.