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Danış F, Kudu E. Point-of-care ultrasound in the acute abdomen and gastrointestinal emergencies: An evidence-based guide and the case for standardisation. World J Gastrointest Surg 2026; 18(11): 125637 [DOI: 10.4240/wjgs.125637]
World J Gastrointest Surg. Nov 27, 2026; 18(11): 125637 Published online Nov 27, 2026. doi: 10.4240/wjgs.125637
Point-of-care ultrasound in the acute abdomen and gastrointestinal emergencies: An evidence-based guide and the case for standardisation
Faruk Danış, Emre Kudu
Faruk Danış, Department of Emergency Medicine, Bolu Abant İzzet Baysal University Faculty of Medicine, Bolu 14030, Türkiye
Emre Kudu, Department of Emergency Medicine, Marmara University School of Medicine, İstanbul 34899, Türkiye
Author contributions: Danış F and Kudu E conceived and designed the review; both authors performed the literature search and the extraction, synthesis and interpretation of the evidence, drafted the manuscript and revised it critically for important intellectual content, designed and reviewed the figures and tables, read and approved the final version to be published, agree to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
AI contribution statement: AI tools, specifically GPT-5.5, were used solely for language polishing and for clarifying the wording of the reviewers' comments during revision. No AI tool was used to generate research data, to select or interpret the diagnostic estimates reported here, to formulate conclusions, or to generate or select references. All AI-assisted content was critically reviewed and revised by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Emre Kudu, MD, Associate Professor, Department of Emergency Medicine, Marmara University School of Medicine, Maltepe Başıbüyük Yolu Sok. No. 9/1 Maltepe, İstanbul 34899, Türkiye. ekudu@marmara.edu.tr
Received: July 14, 2026 Revised: August 12, 2026 Accepted: October 8, 2026 Published online: November 27, 2026 Processing time: 123 Days and 5.6 Hours
Abstract
Point-of-care ultrasound (POCUS) is embedded in emergency assessment of acute abdominal pain, yet its evidence is scattered across emergency, surgical, anaesthetic and radiology journals. This structured narrative review synthesises four applications: (1) Small-bowel obstruction; (2) Gastric aspiration-risk assessment; (3) Non-traumatic free intraperitoneal fluid; and (4) Biliary disease including cholangitis. Sources came from a purposive search of PubMed, Scopus and Web of Science through August 2026, favouring the highest available evidence per application; it was English-language only, unregistered, and without review-level risk-of-bias appraisal or de novo pooling. We report thresholds, pooled sensitivities and specificities, likelihood ratios and, where retrievable, heterogeneity and risk-of-bias data. POCUS for small-bowel obstruction and cholecystitis is primarily a rule-in tool: A negative scan does not reliably exclude disease, and neither defines aetiology, ischaemia or perforation, for which computed tomography remains necessary. For non-traumatic free fluid the strongest rule-in evidence concerns suspected ectopic pregnancy; gastric POCUS stratifies aspiration risk against surrogate endpoints. We contribute an integrated, symptom-based, pretest-probability-driven algorithm with a competency precondition, a non-diagnostic exit and a defined action for every result; it is not prospectively validated. Dispersion across operators, thresholds and reference standards exceeds the margins bedside decisions turn on; we argue standardisation, not further accuracy estimation, is rate-limiting.
Core Tip: This review integrates emergency point-of-care ultrasound for small-bowel obstruction, gastric aspiration risk, non-traumatic free fluid and biliary disease into one symptom-based, pretest-probability-driven algorithm, giving numeric thresholds, likelihood ratios and an explicit action for every result, including non-diagnostic scans. The algorithm has not been prospectively validated. Assembling the evidence also shows that dispersion across operators, thresholds and reference standards, together with absent reliability data for several core measurements, makes standardisation rather than further accuracy estimation the most likely rate-limiting step, a proposition this review frames as testable.
