The diagnosis section of this article cannot go uncontested (1). The authors attach only minor importance to ultrasound. The reason given for this is that displaced gases would quickly limit its utility. This is untrue. Ultrasound must be performed from below in suspected ileus; rising gases then cause no problem. If this advice is heeded, ultrasound is a definitive diagnostic method in many situations (2, 3). A major advantage of it is evaluation of motility and perfusion; contrast agents can be used if needed. The details of ultrasound diagnosis of ileus can be found in textbooks on the subject. Current guidelines establish ultrasound as the first-line method of diagnosis of diverticulitis (4).

X-ray of the whole abdomen is obsolete as a result of its low specificity and sensitivity, for the reasons stated in the article, and should not be performed.

Failure to use diagnostic ultrasound is a glaring shortcoming and should give the authors cause for critical scrutiny of training and outcomes of teaching. The 2011 German X-ray regulation (Section 23) (1) stipulates that X-ray is only to be used if there is an indication that justifies it and that other methods with the same healthcare benefit and no […] radiation exposure should be considered. Thus there are even legal reasons for requiring expertise in ultrasound for intestinal diagnostics. Simply repeating the persistent—and false—premise that ultrasound diagnosis is particularly subjective and dependent on the person who performs it gets us nowhere.

DOI: 10.3238/arztebl.2018.0008a

Dr. med. Matthias Lang

Wieblingen

Germany

langsbu@web.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Vilz TO, Stoffels B, Straßburg C, Schild HH, Kalff JC: Ileus in adults—pathogenesis, investigation and treatment. Dtsch Arztebl Int 2017; 114: 508–18 VOLLTEXT
2.
Taylor, Mark R: Adult small bowel obstruction. Acad Emerg Med 2013; 20: 528–44 MEDLINE
3.
Nylund K, Maconi G, Hollerweger A, et al.: EFSUMB recommendations and guidelines for gastrointestinal ultrasound. Ultraschall Med 2017; 38: e1–15 CrossRef MEDLINE
4.
AWMF: S2k Leitlinie Divertikelkrankheit / Divertikulitis www.awmf.org/uploads/tx_szleitlinien/021–020l_S3_Divertikelkrankheit_Divertikulus_2014–05.pdf (last accessed on 30. October 2017)
1.Vilz TO, Stoffels B, Straßburg C, Schild HH, Kalff JC: Ileus in adults—pathogenesis, investigation and treatment. Dtsch Arztebl Int 2017; 114: 508–18 VOLLTEXT
2.Taylor, Mark R: Adult small bowel obstruction. Acad Emerg Med 2013; 20: 528–44 MEDLINE
3.Nylund K, Maconi G, Hollerweger A, et al.: EFSUMB recommendations and guidelines for gastrointestinal ultrasound. Ultraschall Med 2017; 38: e1–15 CrossRef MEDLINE
4.AWMF: S2k Leitlinie Divertikelkrankheit / Divertikulitis www.awmf.org/uploads/tx_szleitlinien/021–020l_S3_Divertikelkrankheit_Divertikulus_2014–05.pdf (last accessed on 30. October 2017)

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