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Case Reports
. 2018 Jan 9;2(1):21-25.
doi: 10.5811/cpcem.2017.11.35890. eCollection 2018 Feb.

The "Black-and-White Cookie" Sign - A Case Series of a Novel Ultrasonographic Sign in Gastric Outlet Obstruction

Allison Cohen  1 , Mark Foster  1 , Brendon Stankard  1 , Maxine Owusu  1 , Mathew Nelson  1
Affiliations
Case Reports

The "Black-and-White Cookie" Sign - A Case Series of a Novel Ultrasonographic Sign in Gastric Outlet Obstruction

Allison Cohen et al. Clin Pract Cases Emerg Med. .

Abstract

Gastric outlet obstruction (GOO) is a rare condition occurring as a consequence of numerous processes that prevent gastric emptying. Presenting symptoms of GOO are non-specific and include nausea, vomiting, epigastric discomfort and decreased appetite. The diagnosis of GOO is often challenging. Emergency physicians must have a heightened awareness of GOO to ensure proper diagnosis and rapid treatment. Although the gold standard for diagnoses of GOO is endoscopy, many patients are identified by computerized tomography imaging. Point-of-care ultrasound (POCUS) is a rapid and non-invasive technique for evaluating patients in the emergency department. Previous literature has validated the use of ultrasound in diagnosing various intra-abdominal pathologies including bowel obstructions and appendicitis; however, there is limited research on evaluating gastric disease.1 We report three cases of GOO diagnosed with the "black-and-white cookie" sign on POCUS.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1ab
Image 1ab
a) Sagittal orientation point-of-care ultrasound (POCUS) with “black-and-white cookie” sign seen by white arrow with division of stomach contents. Inferior vena cava (blue star) seen distal to the stomach; b) POCUS of dilated, fluid-filled stomach with thickened stomach wall (blue arrow).
Image 2ab
Image 2ab
a) Point-of-care ultrasound (POCUS) with dilated stomach and surrounding intraperitoneal free fluid (blue arrow); b) POCUS with “black-and-white cookie” sign seen by white arrow with division of stomach contents.
Image 3
Image 3
a) Point-of-care ultrasound (POCUS) with dilated stomach with visible stomach fold (blue star) and bidirectional flow of stomach contents; b) POCUS with “black-and-white cookie” sign seen by white arrow with division of stomach contents.
See this image and copyright information in PMC

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