Jejunum Sonography – Small Bowel Ultrasound

What is Jejunum Sonography?

Jejunum sonography is an imaging procedure that uses ultrasound waves to examine the middle portion of the small intestine – the jejunum. The jejunum connects the duodenum to the ileum and plays a central role in the absorption of nutrients. Ultrasound imaging provides a radiation-free, non-invasive, real-time visualization of this bowel segment.

How Does the Examination Work?

During jejunum sonography, a handheld transducer (probe) is placed on the surface of the abdomen. High-frequency sound waves are emitted and reflected at tissue interfaces of different densities. The resulting echo patterns are converted into a live image displayed on a monitor. The examiner can assess the bowel wall thickness, wall layer structure, peristalsis (intestinal movement), and any fluid accumulations or masses.

Preparation

Fasting for several hours before the examination is generally recommended to minimize interference from intestinal gas caused by food intake. In some cases, oral contrast agents such as water or dedicated ultrasound gel solutions are administered to improve visualization of the jejunal lumen. This technique is referred to as hydrosonography or contrast-enhanced bowel sonography.

Clinical Indications

Jejunum sonography is used in a variety of clinical settings:

• Crohn's Disease: Assessment of wall thickening, stenoses, and inflammatory changes in the jejunum
• Coeliac Disease: Detection of altered bowel wall structure and reduced peristalsis
• Bowel Obstruction: Identification of mechanical blockages and pre-stenotic dilatation
• Small Bowel Tumours: Visualization of masses or abnormal wall changes
• Mesenteric Vascular Disease: Evaluation of intestinal blood flow using Doppler sonography
• Unexplained Abdominal Pain: Differential diagnostic workup in chronic or acute abdominal complaints

Advantages of Jejunum Sonography

Compared to other imaging modalities, sonography of the jejunum offers several key benefits:

• No radiation exposure (unlike CT or X-ray)
• Real-time assessment of bowel motility
• Cost-effective and widely available
• Repeatable without risk to the patient
• Can be complemented by Doppler analysis for blood flow assessment

Limitations

The diagnostic value of jejunum sonography may be limited by overlying intestinal gas, obesity, or inadequate patient preparation. In cases where deep bowel segments are poorly visualized, complementary imaging such as MR Enterography (MR-Sellink), CT Enterography, or capsule endoscopy may be required. Examination quality also depends significantly on the experience of the operator.

Clinical Relevance

In gastroenterology, jejunum sonography is a valuable tool for monitoring chronic inflammatory bowel diseases. In particular, Crohn's disease – which frequently affects the jejunum and terminal ileum – can be regularly assessed without radiation exposure, making sonography ideal for long-term follow-up. The technique is also preferred in paediatrics, as children are especially sensitive to ionizing radiation.

References

1. Strobel D. et al. - Diagnostics and therapy of inflammatory bowel disease using ultrasound. German Society for Ultrasound in Medicine (DEGUM), 2022.
2. Panes J. et al. - Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Alimentary Pharmacology and Therapeutics, 2011.
3. Nylund K. et al. - EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound. Ultraschall in der Medizin, 2017.