Abdominal auscultation represents a fundamental part of the clinical examination,
especially in patients with gastroenterological complainants [
- Moll van Charante E.P.
- de Jongh T.
Auscultation of the abdomen.
]. However, over the last years, many divergent views have emerged on the value and
utility of abdominal auscultation in daily clinical practice. As well known, both
physiological and pathological bowel sounds are generated by peristaltic contractions
- Gu Y.
- Lim H.J.
- Moser M.A.
How useful are bowel sounds in assessing the abdomen?.
]. Despite the ability to perform a complete and adequate physical examination is still
an essential part of the medical education, medical schools often teach in different
way how to listen to the bowel sounds. Indeed, in some cases, it is highly recommended
to perform the abdominal auscultation prior the palpation, whereas other schools teach
to auscultate after the palpation. The rationale for the use of the former technique
has been justified by the fact that palpation could trigger the peristalsis, confounding
the physical exam. However, there are fewer evidences that could justify this approach.
Felder et al. in their prospective study reported that auscultation of bowel sounds
is not useful in clinical practice when differentiating subjects with normal versus
pathological bowel sounds, because the listener frequently assumed an incorrect diagnosis
- Felder S.
- Margel D.
- Murrell Z.
- Fleshner P.
Usefulness of bowel sound auscultation: a prospective evaluation.
]. Other authors concluded that auscultation is of very limited diagnosis utility and
a prolonged listening of bowel sounds is an ineffective use of time despite it could
reveal pathological findings [
Cope's early diagnosis of the acute abdomen.
]. Massey et coll. in 2012 suggested that the routine assessment of bowel sounds for
resolution of post-operative ileus was an unnecessary procedure [
Return of bowel sounds indicating an end of postoperative ileus: is it time to cease
this long-standing nursing tradition?.
]. Considering these findings, the question is: can we consider abdominal auscultation
as an outdated practice? Firstly, the lack of consensus in teaching the abdominal
auscultation is a major issue in this field. If any kind of palpation could influence
the pathological findings at clinical examination, it'd be a big deal in daily clinical
practice! Secondly, the different types of study which have analysed the different
inter-observer agreement in abdominal auscultation have often considered this part
of clinical examination as a diagnostic test. Indeed, this manoeuvre is fundamental
rising the clinical suspicion, which should be confirmed by further tests. Moreover,
many co-variables could influence the results of these types of studies, as the physician
skill's, the type and severity of patient's disease, the presence of abdominal fat,
etc. Furthermore, the abdominal auscultation must be evaluated in the clinical scenario.
In fact, Durup-Dickenson et al. suggested that the value of abdominal auscultation
increases with the addition of previous medical history and evaluation of symptoms
- Durup-Dickenson M.
- Christensen M.K.
- Gade J.
Abdominal auscultation does not provide clear clinical diagnosis.
]. The important technical improvements in imaging techniques as, computed tomography
(CT) or ultrasonography (US), have scaled down the role of physical examination over
the years. It is important to remember that the physical examination remains and should
remain in the future as the cornerstone of differential diagnosis, guiding any clinical
or diagnostic decisions. In this setting, abdominal auscultation, represents a main
stem of physical examination, especially in patients with abdominal symptoms. It would
be a mistake considering this part of the clinical assessment as an outdated practice.
If this happens, the patient-centre perspective will be lost in favour of an imaging
centre-perspective. As consequence, the risk is to perform a diagnosis of bowel obstructions
or ileus only putting the patient inside a “magic machine”, as the CT, without any
prior physical evaluation, and waiting of the final diagnosis. Indeed, as clinicians,
prior to any other instruments, we must use eyes, ears and hands. Doubtless, at the
same time we should also look to the future, using new technologies. Indeed, from
a theoretical point of view, abdominal auscultation should lead us to prescribe a
bedside ultrasound or abdominal CT, in order to make the correct diagnosis. However,
we believe that it is important to still teach to the future generations of doctors
the value of the abdominal auscultation. In fact, digitalization of teaching has partially
changed the interactions between teachers and medical students [
- Zuin M.
- Rigatelli G.
- Zuliani G.
- Faggian G.
- Roncon L.
The secret of the questions: medical interview in 21st century.
]. In this setting, it is important that specialist in internal medicine, which are
well-trained in semeiology, emphasise the role of this semeiological manoeuvre between
physicians and teaching it to the next generation of colleagues. Besides, what we
are without a stethoscope in our pocket?