WFUMB Course Book
GASTROINTESTINAL ULTRASOUND
19. Gastrointestinal Ultrasound
Kim Nylund, Odd Helge Gilja, Christoph F Dietrich
Keywords: Inflammatory bowel disease, appendicitis, diverticulitis, bowel
obstruction, tumours of the GI tract
19.1. Introduction
As a cross-sectional imaging technique gastrointestinal ultrasound (GIUS) similarly
to CT and MRI, has the benefit of both being able to display the entire gastrointestinal
tract and to examine the extra-intestinal features. In contrast to other techniques, it
can be performed without preparation. Since it is non-invasive and real-time we can
also study anatomy and physiology in an unsedated patient.
There are limitations such as body habitus and air limiting the penetration especially
of high frequency probes. It is also challenging to accurately describe the location
of the pathology in the small bowel, more so than for CT and MRI. Finally, although
not a problem unique for GIUS many of the findings on cross sectional imaging are not
disease specific which may hamper differential diagnostics.
GIUS is established for inflammatory bowel disease (IBD) and other diagnosis with
inflammation such as appendicitis and diverticulitis. Also, the usefulness of GIUS as
the first imaging modality in suspected bowel obstruction is well documented. Since
ultrasonography often is the first imaging procedure used when evaluating a patient
with abdominal complaints it also very useful to know how other diseases present
during GIUS examination. This is reflected in how this chapter is outlined. The first part
is mainly focused on the disorders where GIUS is the clear first option in imaging. The
second part focuses on the expected GIUS findings in other relevant GI-disorders.
Clinical indications of gastrointestinal ultrasound
Symptom based: Clinical suspicion:
Chronic diarrhoea Appendicitis
Acute abdominal pain Diverticulitis
Chronic stomach pain Bowel obstruction
Weight loss IBD
Abdominal distention Chronic or subacute bowel ischemia
Vomiting and nausea
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19.
19.1. Inflammatory disorders of the GI tract
19.1.1. Crohn’s disease
The main finding in Crohn’s disease is circumferential bowel wall thickening (>3
mm) in the affected bowel segments. The degree of inflammation is related to the
degree of bowel wall thickening. In areas with ulcerations and extensive edema
there is loss of the normal layered structure of the GI wall. Furthermore vessels can
be detected inside the affected bowel wall using colour Doppler and if available,
contrast-enhanced ultrasound (CEUS). A very typical finding in Crohn’s disease is
creeping fat which is seen as a hyperechoic layer around bowel. Furthermore, free
fluid and reactive lymph nodes in the mesentery is often seen close to the affected
bowel.
Ultimately, none of these findings are indicators of Crohn’s disease exclusively, but
the typical location of these findings such as the terminal ileum and/or a patchy
distributions (skip lesions) are highly indicative of Crohn’s disease.
The activity of Crohn’s disease is mainly related to the thickness of the affected
bowel wall, the extent of disease and the vessel density on colour Doppler. For
practical purposes bowel wall thickness alone in the worst affected segment is a
very good indicator of disease activity (Fig 19.1 a, b, c, d).
View enlarged image
Fig 19.1a
Bowel wall thickening in
Crohn’s disease. Slight wall
thickening of the wall in the
terminal ileum in a patient
with mild disease
WFUMB Course Book 19. GASTROINTESTINAL ULTRASOUND

View enlarged image View enlarged image

Fig 19.1d
Fig 19.1b Fatty wrapping is a typical
Bowel wall thickening in finding in Crohn’s disease
Crohn’s disease. Gross and is typically hyperechoic.
thickening of the bowel wall Here it is seen encircling a
with loss of wall layers in a chronically inflamed terminal
patient with severe disease ileum

Abscesses are also hypoechoic, but often have a rounded appearance due to the
intracavital pressure. Hyperechoic gas bubbles can be seen rising towards the
View enlarged image
probe and sometimes hyperechoic debris can be seen towards the bottom (Fig
19.2 a, b, c, d). GIUS has high sensitivity for detecting all these complications,
but performs poorer than CT and MRI in the deep pelvic region and in the very
obese. The use of CEUS can improve the distinction of inflammatory masses from
abscesses (Fig 19.3).

View enlarged image

Fig 19.1c
In active Crohn’s disease
multiple dilated vessels can
be seen inside the bowel
wall using colour Doppler

A thickened, stiff small bowel wall segment with a narrow lumen and no peristalsis Fig 19.2a
indicates a stenosis. This diagnosis is more certain if there is prestenotic dilatation Crohn’s disease
>2.5 cm in a fasting patient. Fissures and fistulas can be seen as hypoechoic complications. Abscess in
tracts originating from a part of the bowel wall where there is loss of wall layers. association with an inflamed
Sometimes the gas inside the tract can be identified as hyperechoic, tiny elements small bowel loop central in
within the tract. the abdomen

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View enlarged image View enlarged image

Fig 19.2b Fig 19.2d

Crohn’s disease Crohn’s disease
complications. A fistula tract complications. The
can be seen going out from ultrasonogram shows
affected terminal ileum going grossly dilated intestinal
into an abscess behind the loop just prior to the stenosis
urinary bladder in Crohn’s disease

View enlarged image View enlarged image

Fig 19.3a
Using ultrasound contrast
Fig 19.2c you can separate and
Crohn’s disease infiltrate from an abscess.
complications. A stenosis in In this case the B-mode
the terminal ileum is shown image shows and infiltrate
with the transition to normal in relation to inflamed small
wall thickness bowel

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View enlarged image View enlarged image

Fig 19.3b
Using ultrasound contrast
you can separate and
infiltrate from an abscess.
In the contrast image a
small abscess in the central
part of the infiltrate is seen Fig 19.4a
as a perfusion defect Mild ulcerative colitis

A thickened, stiff bowel wall with few visible vessels on colour Doppler and a Ultrasound is well suited for detecting the extent of the disease. Again, the thickness
pronounced proper muscle indicates development of fibrosis in the bowel wall. of the bowel wall is related to the disease activity and a reduction in bowel wall
In the follow up of Crohn’s patients the reduction of bowel wall thickness is a thickness indicates response to treatment.
clear indicator of treatment effect. Retained bowel wall thickness suggest lack of
treatment effect while increasing bowel wall thickness suggest an increasing risk
of surgery.
View enlarged image

19.1.2. Ulcerative colitis

As in Crohn’s disease the main finding in ulcerative colitis is circumferential wall

thickening, but limited to the colon. Currently, 3 mm is used as cut-off value for
pathological thickened wall. Since ulcerative colitis is limited to the mucosa the
loss of wall layers is seen less frequently than in Crohn’s disease, but occurs in
severe disease. Typically dilated intramural vessels can be detected with colour
Doppler. The distribution is continuous from the rectum to the proximal location of
disease in the colon (Fig. 19.4 a, b, c, d). The sensitivity for detection of proctitis Fig 19.4b
is considerably less than for the rest of the colon. Visibility of the rectum improves Severe ulcerative colitis.
significantly through a well-filled urinary bladder. Accordingly, the patients should Note the destruction of wall
be instructed not to void before GIUS examination. layers

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View enlarged image
Fig 19.4c
Colour Doppler reveals
multiple dilated vessels
inside the inflamed
transverse colon in patient
with active ulcerative colitis
View enlarged image
Fig 19.4d
Be aware that pseudo-polyps
can cause a thickening of the
bowel wall. Here seen in the
transverse colon in a patient
with quiescent disease.
Between the polyps, normal
wall with retained stratification
can be seen
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19.1.3. Acute appendicitis
When available ultrasound should be the first imaging modality used for diagnosing
appendicitis and CT or MRI reserved for inconclusive or difficult cases.
When diagnosing appendicitis with GIUS the investigator should start at the point
of maximum tenderness or identify the appendix where it originates from the
coecal pole. By gently increasing the pressure with the ultrasound probe (graded
compression) over the region of interest the distance to the appendix is made as
short as possible and the overlying bowel gas is displaced. In adults with typical
histories, an appendiceal diameter between 6-8 mm suggests appendicitis while a
diameter >8 mm is a clear sign of appendicitis (Fig 19.5).
Other signs are probe tenderness over the visualised appendix, incompressibility
of the appendiceal lumen, appendicolith, hypervascularity in the wall using colour
Doppler or loss of the normal wall layers. Hyperechoic fatty tissue surrounding the
appendix can also be seen. Loss of wall layers in the appendix or an enclosed fluid
collection (abscess) indicates a complicated appendicitis (Fig 19.6). Free fluid close
to appendix is also a frequent finding but is typically a transudate or exudate and
does not necessarily suggest perforation.
If the normal appendix can be visualised in its entire length appendicitis can be
excluded. The normal appendix can be seen in about 50% of adults with adequate
training of the sonographer.
View enlarged image
Fig 19.5
Thickened, inflamed
appendix is shown
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View enlarged image
Fig 19.6
In a patient with six weeks
history of fever, abdominal
pain and painful walking in
the last days, a retrocecal
abscess can be seen in
a patient with perforated
appendicitis
19.1.4. Diverticulitis
As for appendicitis GIUS should be the mainstream of diagnostic imaging
in diverticulitis and CT or MRI should be reserved for inconclusive cases.
In suspected diverticulitis typically there is pain located in the left lower quadrant,
fever and elevated CRP. The ultrasonographer should either put the ultrasound
probe at the point of maximum tenderness or systematically scan through the colon.
Graded compression helps with pushing away gas and getting closer to the region
of interest. Regular diverticula are typically seen as hypoechoic, outpouchings of
the colon wall with gaseous faeces or fecaliths (Fig 19.7). The proper muscle is
typically thicker in a region with diverticula.
When diverticula become inflamed there is increasing oedema in the adjacent
bowel wall with wall thickness >5 mm. Around the hypoechoic diverticula there is
hyperechoic fatty tissue due to the inflammatory reaction. The inflamed fatty tissue
and diverticula cannot be compressed due to the oedema. Importantly, the findings
should correspond to tenderness with probe compression.
As in appendicitis complications with perforation, fistulas and abscesses are
important to identify as they change the prognosis managing strategy. Abscesses
are hypoechoic, rounded lesions with gas rising towards the probe while fistulas
are hypoechoic tracts.
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19. GASTROINTESTINAL ULTRASOUND
Complications arising from colon located deep in the pelvis are harder to identify by
ultrasound and in these cases CT is superior to GIUS. Contrast-enhanced ultrasound
helps in the differentiation of inflammatory masses and abscesses as the former is
well perfused while an abscess has no contrast enhancement in the pus-filled centre.
19.2. Intestinal emergencies
Abdominal ultrasound is frequently performed in patients presenting with acute
abdomen. Differential diagnosis in these patients are typically acute appendicitis
and diverticulitis as already presented and bowel obstruction where GIUS is well
documented. Other potential diagnoses are bowel ischemia and perforation.
Although GIUS might not be the best tool for diagnosing these conditions, it is still
important to recognize their signs when examining these patients.
View enlarged image
Fig 19.7
An inflamed diverticula with
a thickened hypoechoic
wall and with hyperechoic
content can be seen
originating from sigmoid
colon
19.2.1. Bowel obstruction
In patients with suspected bowel obstruction the bowel should be scanned starting
from the stomach and continuing in the distal direction by moving obliquely from the
epigastrium to the right fossa before tracing the colon in the distal direction. Since
air rises it may obstruct the view in a supine patient. This can be solved by scanning
from the flanks.
WFUMB Course Book 19. GASTROINTESTINAL ULTRASOUND

If bowel obstruction is present, often a stomach filled with hypoechoic content can be View enlarged image
found in the epigastrium or upper left flank. When there is a gastric outlet problem,
this may be the only finding. In small bowel obstruction this is not a mandatory
finding, however, particularly if the patient vomited before the examination.
Mandatory findings are, however, a dilated small bowel (≥3 cm) proximal to the
obstruction and collapsed distal to the obstruction (Fig 19.8 a,b). If the obstruction
is not chronic there is hyperperistalsis proximal to the obstruction and to and fro
movements of the content. The luminal content is often hypoechoic and the valvulae
conniventes clearly seen in the jejunum. Later the luminal content tend to become
fecalized and more hyperechoic and the peristalsis subsides. Fig 19.8b
The level of obstruction is determined by scanning systematically through the A patient with abdominal
bowel until collapsed bowel loops are found. Often the luminal content is more pain and vomiting had
dilated small bowel and a
hyperechoic just proximal to the stenosis. Sometimes the cause of obstruction can
femoral hernia was revealed
be found, but this is difficult to determine if it is due to adhesions, which is the cause as the cause
in about 80% of cases.

If the obstruction arises in the large bowel it can be difficult to determine the level Hence, a dilated hyperperistaltic small bowel and colon filled with air and faeces
and the cause since air is often obscuring the lumen. To diagnose obstruction, the suggest large bowel obstruction while a dilated, aperistaltic small bowel with a
large bowel luminal diameter should be >4.5 cm. Finally, a paralytic ileus will also similar colon suggest a paralytic ileus.
cause dilated, fluid small bowel, but without visible peristaltic movements. Since
the paralysis is rarely limited to the small bowel, however, the colon will also be 19.2.2. Bowel ischemia
filled with faecal content.
Failure of the circulation in the GI tract can present as different clinical syndromes.
In the case of acute arterial mesenteric ischemia ultrasound is not the first option
while in ischemic colitis, the most common acute circulatory disorder of the GI
View enlarged image tract, GIUS can be very useful. GIUS is also useful for the detection of acute
mesenteric vein ischemia. Chronic mesenteric ischemia will be presented later
under “Miscellaneous” as it’s not an intestinal emergency.
Ischemic colitis can be separated into a transient and gangrenous form and
most frequently located in the left colon starting from the left flexure and ending
somewhere in the distal sigmoid colon. Again, the gangrenous colitis is a form of
acute mesenteric ischemia and need immediate surgery. The clinical presentation
is clearly different from transitory ischemic colitis where the patients suffer acute
abdominal pain followed by bloody stools. Often circulation has been re-established
upon admission and the pain is improving while the diarrhoea is more dominant.
Fig 19.8a An early ultrasound examination will show a thickened segment of the bowel with
A patient with abdominal loss of layers and few if any vessel signals on colour Doppler. In the reperfusion
pain and vomiting had phase more intramural vessels can be identified, but the arterial acceleration time
dilated small bowel is reduced due to increase upstream vascular resistance (Fig 19.9 a, b, c).

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View enlarged image
Fig 19.9a
Often a patient with
ischemic colitis is examined
in the reperfusion phase of
ischemic colitis.
Edematous wall with a slight
loss of stratification
View enlarged image
Fig 19.9b
Often a patient with
ischemic colitis is examined
in the reperfusion phase of
ischemic colitis. With colour
Doppler plenty of dilated
vessels can be found
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19. GASTROINTESTINAL ULTRASOUND
A short ischemic episode usually such as in ischemic colitis only give mucosal
necrosis and the changes are quickly reversed.
In the event of an occlusion of the portal or mesenteric veins this will cause
immediate bowel edema in the affected area as well as ascites.
View enlarged image
Fig 19.9c
Often a patient with
ischemic colitis is examined
in the reperfusion phase of
ischemic colitis. By adding
pulse wave Doppler in
intramural arteries, typically
a delayed acceleration time
can be detected
19.2.3. Perforation
The main finding in a patient with bowel perforation is the presence of gas in the
abdominal cavity. Gas frequently makes ultrasound images difficult to interpret
which is a limiting factor for this condition. When abdominal ultrasound is
performed and perforation is suspected special consideration should be given to
the epigastric region in the supine position and the right hypogastric region in the
left lateral position. In both these cases free gas in the abdominal cavity will rise
and interposition itself between the abdominal wall and the liver obstructing the
view of the liver (if there is a sufficient amount of gas) or causing areas of gas-
shadowing. The liver can be seen by gently pushing with the probe forcing the air
away and making contact with the liver again. Although ultrasound is better than a
plain x-ray for detecting air in these cases, abdominal CT is clearly the best choice
in uncertain cases.
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Special GIUS signs and their relation to disease:
Finding:
Thickened stomach wall (>1cm)
Thickened bowel wall (>3mm)
Thickened appendix (>6mm)
Loss of bowel wall layers
Loss of haustrations
Pseudo-kidney/target sign
Colour Doppler signals (> that 1 within
bowel wall)
Reduced vascular resistance bowel wall
Increased arterial acceleration time bowel wall
Increased velocity celiac trunk
Increased velocity superior mesenteric artery
Reduced peristalsis, relative to other bowel
loops (if MMC phase III)
Increase peristalsis relative to other bowel
loops (if MMC phase III)
Dilation small bowel (>2,5cm)
Hyperechoic fat (thickened bowel wall)
Stenosis (thickened bowel, narrow lumen,
no peristalsis)
Fistula (hypoechoic tract )
Abscess (rounded hypoechoic lesion with air) Perforating Crohn’s disease,
appendicitis, diverticulitis
Disease:
Linitis plastica, Mb. Menetrier, Lym-
phoma, ulceration (focal)
Infections and inflammatory disorders,
reduced venous return, malignancy
Appendicitis
Tumours (focal), ischemia (diffuse),
inflammation (both)
Chronic inflammation (Typically IBD)
Tumours, localized and severe inflammation
Infections and inflammatory disorders
Infections and inflammatory disorders
Transitory bowel ischemia
Chronic bowel ischemia/Abdominal angina
Chronic bowel ischemia/Abdominal angina
Fibrosis, paralytic ileus, motility
disorders
Mechanic bowel obstruction (early),
celiac disease
Mechanic or paralytic bowel
obstruction if acute, stenosis without
clinical bowel obstruction if chronic
Crohn’s disease, diverticulitis
Crohn’s disease, tumours
Perforating Crohn’s disease,
appendicitis, diverticulitis
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19.3. Miscellaneous
Since abdominal ultrasound often is the first imaging method performed in a patient
with abdominal complaints, the examiner will come across diseases in which GIUS
may not necessarily be fully diagnostic. It will, however, guide the physician in the
direction both by excluding certain diagnosis and by detecting regions with pathology.
However, in some cases the findings observed by GIUS are directly diagnostic.
19.3.1. Tumours in the GI tract
GIUS is able to detect target lesions or “pseudo-kidney sign” indicating a tumour
in the GI tract. GIUS is often helpful in detection and localisation of a tumour,
particularly in the small bowel where endoscopic options are limited. Also,
ultrasound can to some degree can suggest what type of tumour it is based on
macroscopic criteria. For instance US may suggest from which wall layer within the
GI wall the tumour originates, as typically observed in GIST. Furthermore, GIUS
can also be used to detect locoregional lymph nodes.
Linitis plastica is an aggressive adenocarcinoma diffusely infiltrating submucosa
of the gastric wall. If you in a patient with epigastric pain, postprandial discomfort,
and weight loss observe a stomach wall over 1 cm thick with loss of wall layers,
this suggests the diagnosis and should promptly lead to gastroscopy with deep
biopsies (Fig 19.10).
View enlarged image
Fig 19.10
A grossly thickened gastric
wall with loss of wall layers
can be found in patients
with linitis plastica
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View enlarged image
Fig 19.11
Burkitt’s lymphoma in the
gastrointestinal tract
Lymphomas in the GI tract typically present as gross segmental thickening of the
bowel wall and loss of wall layers with hypoechoic, rounded lymph nodes nearby.
They can be found in all parts of the GI tract, but are more common in the proximal
parts (Fig. 19.11). Adenocarcinomas have a similar appearance, but more often
presents with symptoms of obstruction.
View enlarged image
Fig 19.12a
GIST. In a patient with
abdominal pain and
episodes of subileus, a
hypoechoic, rounded mass
was found in the wall of a
small bowel segment. The
tumour compressed the
lumen causing symptoms
and could be seen
emerging from the proper
muscle layer.
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19. GASTROINTESTINAL ULTRASOUND
View enlarged image
Fig 19.12b
GIST. Just nearby a round
lymph node was found in
the mesentery. The patient
was operated and histology
confirmed a GIST with
lymph node metastasis.
Gastrointestinal stromal tumours (GIST) are often localised in the stomach and
proximal small bowel. They typically appear rounded, and outside the lumen and
with a high frequency probe you may observe that they originate from the proper
muscle layer (Fig. 19.12 a, b). The larger and more heterogeneous they appear,
the higher is the malignant potential.
View enlarged image
Fig 19.13
Neuroendocrine tumour
located in the mesenterium
WFUMB Course Book 19. GASTROINTESTINAL ULTRASOUND

Neuroendocrine or carcinoid tumours are more common in the distal part of

View enlarged image
the bowel towards the terminal ileum and most commonly appear as well-defined,
hypoechoic tumours inside the lumen (Fig 19.13).

The most common malignancy in the GI tract is adenocarcinoma of the colon (Fig.
19.14 a, b). Large, circumferential tumours can sometimes be seen on GIUS as an
irregular, hypoechoic mass with a white centre. During scanning it may resemble
a kidney and this has led to the term “pseudo-kidney sign.”

19.3.2. Intestinal graft versus host disease

When allogenic haematopoietic stem cell transplantation leads to graft versus

host disease (GVHD) it frequently affects the gastrointestinal tract. Developing Fig 19.14b
3-5 weeks after transplantation the patients often have high volume secretory A stricturing tumour of the
sigmoid colon
diarrhoea and stomach pain and sometimes nausea, vomiting and anorexia. The
main findings on GIUS are segmental thickening of the bowel most pronounced
in the submucosa, hyperaemia and sloughing off of the mucosa seen as an extra
echo-rich line (Fig 19.15). Frequently, the affected bowel segments are fluid-filled
and dilated.

View enlarged image View enlarged image

Fig 19.15a
Image from acute GVHD
of the colon. Grossly
thickened bowel wall
Fig 19.14a is shown with extra
Typical “pseudo-kidney” hyperechoic lines towards
sign is seen in a patient the lumen representing the
with colon cancer sloughing off of the mucosa

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View enlarged image
Fig 19.15b
Image from acute GVHD of
the colon. Hyperaemia with
colour Doppler
View enlarged image
Fig 19.15c
Image from chronic GVHD
of the colon. The colonic
wall is shown after 4
months. The stratification
is clear, but still the
submucosa is thickened
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19. GASTROINTESTINAL ULTRASOUND
View enlarged image
Fig 19.15d
Image from chronic GVHD
of the colon. The sigmoid
colon is shown thickened,
stiff and stenotic. The
luminal content is still fluid
like even though we are in
the distal part of the colon
19.3.3. Intussusception
Intussusception is a condition where one part of a bowel loop slides inside another
part and this may cause acute bowel obstruction. Although intussusception most
frequently occurs in children <12 months, it can also occur in adults. Intussusception
has a very characteristic appearance on ultrasound.
Since the intussuscepted bowel is engulfed together with its mesentery the
structure appears as a multi-layered, tumour in cross section (“onion sign”) with a
hyperechoic, semi lunar area towards the centre (Fig 19.11). In the longitudinal the
hyperechoic mesentery may appear as a triangular structure.
Most adults with symptomatic intussusception have an underlying cause that
triggers the invagination. It may be a tumour, polyp or inflammation causing it
(Fig 19.16 a, b). If invaginated bowel loops are detected, the examiner should
carefully study the surrounding bowel segments to explore if the underlying cause
can be found. In patients with diseases of the bowel causing hyperperistalsis such
as Crohn’s disease or celiac disease, intermittent, asymptomatic episodes of
intussusception can occur. These harmless episodes of intussusception typically
appear and resolve quickly during an examination without the patient reporting
any complaints.
WFUMB Course Book 19. GASTROINTESTINAL ULTRASOUND

View enlarged image Tips and tricks

Fig 19.16a
The image shows a
classical “onion sign” in
a young female patient
with invagination. The
patient was operated and
invagination due to a polyp
was confirmed. The polyp
can be seen as a dark
greyish “sausage” in the
center of the invaginate
together with mesentery in
white
Beware of previous bowel resections as
this makes patient anatomy harder to
understand
Always investigate at the point maximum
of the patient’s pain
A collapsed colon can be hidden behind
small bowel segments
In collapsed bowel separate thickened
from pseudo-thickened bowel by
compressing with the probe
By observing the bowel during inspira-
tion adhesions to abdominal wall can be
seen
Small bowel with fixed bends suggests
bowel adhesions or fibrosis of the wall
Frequently small amounts of free fluid is
found close to areas with inflammation
Loss of haustration in colon is an indica-
tion of chronic disease

Recommended reading

View enlarged image
Fig 19.16b
A longitudinal view from a
patient with large polyps
causing the invagination. In
this section the mesentery
can be seen on both sides
of the invaginated bowel
loop on the left side of the
image
• Atkinson NS, Bryant RV, Dong Y, et al. WFUMB Position Paper. Learning
Gastrointestinal Ultrasound: Theory and Practice. Ultrasound Med Biol
2016;42:2732-2742
• Dietrich CF, Hollerweger A, Dirks K, et al. EFSUMB Gastrointestinal Ultrasound
(GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases
ultrasound features. Med Ultrason. 2019;21(3):299-315.
• Dirks K, Calabrese E, Dietrich CF, et al. EFSUMB Position Paper:
Recommendations for Gastrointestinal Ultrasound (GIUS) in Acute Appendicitis
and Diverticulitis. Ultraschall Med. 2019;40(2):163-75.
• Hollerweger A, Maconi G, Ripolles T et al. Gastrointestinaler Ultraschall (GIUS)
bei intestinalen Notfällen ­ Ein EFSUMB-Positionspapier. / Gastrointestinal
Ultrasound (GIUS) in Intestinal Emergencies - An EFSUMB Position Paper.
Ultraschall Med ; 41(6): 646-657, 2020 Dec
• Maconi G, Nylund K, Ripolles T et al. EFSUMB Recommendations and Clinical
Guidelines for Intestinal Ultrasound (GIUS) in Inflammatory Bowel Diseases.
Ultraschall Med. 2018;39(3):304-17.
• Nylund K, Maconi G, Hollerweger A, et al. EFSUMB Recommendations and
Guidelines for Gastrointestinal Ultrasound. Ultraschall Med. 2017;38(3):273-84.
• Nylund K, Odegaard S, Hausken T, et al. Sonography of the small intestine.
World J Gastroenterol. 2009;15(11):1319-30.

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