Ultrasound Pictures of “Peritonitis”

ULTRASOUND PICTURES Peritonitis

Clinical manifestations Peritonitis: Severe clinical picture that may include shock, heart failure, or impaired renal function; tense abdomen, diffuse or localized pain; retention of stool, nausea, vomiting, fever.

ULTRASOUND PICTURES OF Inflammatory peritonitis with paralytic ileus in Crohn disease. Bowel loops (B) are crowded together, dilated, and filled with stool. No evidence of wall thickening or bowel motility. The large psoas muscle (M) is visible posteriorly.

Diagnosis Peritonitis:
History and clinical course: Appendicitis; perforated diverticulitis, ulcer disease
or gallbladder; previous cholecystectomy or common duct surgery; gangrenous
bowel obstruction due to adhesions (prior surgery) or an incarcerated hernia.

Laboratory findings: Inflammatory signs, marked leukocytosis

Ultrasound

Rarely, diagnostic lavage to identify the causative organism

Peritoneal biopsy

Sonographic findings Peritonitis:

- Thickened peritoneum
- Inflammatory peritonitis may cause the matting of bowel loops by adhesions.
- The bowel loops cannot be separated from one another by digital palpation.
- Dilatation of the bowel (due to deficient absorption) with no wall swelling and
decreased or absent peristalsis. Paralytic ileus may result.
-Peritonitis is usually marked by a very cellular exudate, and free fluid in the abdomen often contains high-level internal echoes.

Accuracy of ultrasound diagnosis Peritonitis: Ultrasound can rarely demonstrate the peritonitis itself, but can detect the associated changes. The detection of infected ascites (by percutaneous aspiration) confirms the diagnosis.