BACKGROUND: Emergency physicians frequently encounter patients with acute small bowel obstructions (SBO). Although computed tomography (CT) imaging is the current gold standard in the assessment of patients with suspected SBO in the emergency department, a few studies have examined the use of ultrasound as an alternative imaging technique. METHODS: We evaluated the accuracy of ultrasound performed in the ED by a variety of providers (physicians with various levels of training, physician assistants) compared to CT imaging in 47 patients with suspected SBOs. RESULTS: Our data demonstrated a sensitivity of 93.8％ and a specificity of 93.3％ when compared to abdominal CT, and a sensitivity of 94.3％ and specificity of 95.2％ using a composite endpoint of abdominal CT and discharge diagnosis. CONCLUSION: Ultrasound can play an important role in the identification of small bowel obstructions in ED patients.