How useful are bowel sounds?
Date First Published:
June 13, 2007
Last Updated:
April 7, 2011
Report by:
Clare Lamont, Medical Student (MRI)
Search checked by:
Katherine Potier de la Morandiere, MRI
Three-Part Question:
In [young children with abdominal pain] do [bowel sounds] have [clinical utility in aiding the diagnosis]
Clinical Scenario:
A 3 year old child comes into the Emergency Department complaining of tummy ache. As part of the abdominal examination you listen for bowel sounds. You wonder whether this will aid the diagnosis.
Search Strategy:
MEDLINE 1950 to June week 1 2007 using the OVID interface AND EMBASE 1980 to week 22 2007
Search Details:
[{exp Abdominal Pain/ OR exp Acute abdomen/ OR abdo$ pain.mp} AND {exp auscultation/ OR bowel sounds.mp OR silent abdomen.mp or Borborygmi.mp} AND {exp Physical Examination/ OR examination.mp} AND {exp Diagnosis/ OR exp Diagnosis, Differential/}] LIMIT to human AND English
Outcome:
MEDLINE: 37 papers were found, 36 of which were irrelevant to the clinical question.
EMBASE: 65 papers were found none of which were relevant (excluding 1 duplicate)
The 1 useful paper is described below:
EMBASE: 65 papers were found none of which were relevant (excluding 1 duplicate)
The 1 useful paper is described below:
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain Bohner H et al 1998 Germany | 1254 patients (6-97) with acute atraumatic abdominal pain. Bowel obstruction diagnosed in 3.8% |
Prospective cohort | In patients with bowel obstruction: | sens 39.6% spec 88.6% | No subset analysis for children No power calculation No Gold standard Setting unclear - Emergency Department? |
| Increased bowel sounds | ppv 12.1% npv 97.4% | ||||
| Decreased Bowel sounds | sens 25.0% spec 90.7% | ||||
| ppv 11.2% npv 96.9% |
Author Commentary:
There is surprisingly little evidence for this well established part of medical practice. However, the one paper found was well constructed and of high quality. High specificity of bowel sounds indicated that where abnormal bowel sounds are heard, obstruction can be confidently ruled in. However sensitivity is poor—the presence of normal bowel sounds does not exclude bowel obstruction. Little difference was found between sensitivity and specificity of increased or decreased bowel sounds. More research needs to be done to confirm this paper's findings. At the present bowel sounds need to be used in conjunction with other components of the clinical examination.
Bottom Line:
Listening for bowel sounds can be useful as part of the abdominal examination - bowel sounds have a high specificity, but low sensitivity in the diagnosis of intestinal obstruction. However no one component of the abdominal examination appears to be consistently reliable.
References:
- Bohner H et al. Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain