Introduction: Small bowel obstruction (SBO) is known as a common cause of acute abdominal complaints in the emer-gency department (ED). The modality of choice for the diagnosis of SBO has not yet been established.  This systematicreview and meta-analysis aimed to investigate the accuracy of ultrasonography for the diagnosis of SBO.

Methods: Sys-tematic search was performed on five electronic databases including Medline, Scopus, Web of Sciences, Embase, andCochrane Library, and the retrieval period was from the inception of each database to November 2023.  The quality ofthe included studies were investigated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The pooled values of diagnostic characteristics for ultrasonography were estimated using meta-Disc and Stata statistical soft-ware.Results:Twenty-one studies with a total of 1977 patients were included in the meta-analysis. The pooled estimate for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary ROC curve of ultrasonography for diagnosing SBO were 0.93 (95% CI: 0.91–0.95), 0.8 (95%CI: 0.77–0.83), 5.69 (95% CI: 3.64–8.89), 0.1 (95% CI: 0.07–0.16), 83.51 (95% CI: 18.12–182.91) and 0.96, respectively.

Conclusion: The findings of this meta-analysis showed that the utilization of ultrasonography holds promise as a diagnosticimaging for SBO with high accuracy.  However, additional worldwide studies are essential to get more evidence on thevalue of ultrasonography for the diagnosis of SBO.