Accuracy of Ultrasonography in the Diagnosis of Peritonitis Compared With the Clinical Impression of the Surgeon

Chen, Shyr‐Chyr; Lin, Fang‐Yue; Hsieh, Yeu‐Sheng; Chen, Wei-Jao

doi:10.1001/archsurg.135.2.170

Cited by 23 publications

(25 citation statements)

References 21 publications

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“…Without the comparison of CT with ultrasonography, the value of ultrasonography to detect pneumoperitoneum is undetermined. Although most abdominal ultrasonography examinations used a 5.0-MHz linear-array transducer, our previous studies 4,5 had similar results using a 3.75-MHz curved-array transducer.…”

Section: Limitationssupporting

confidence: 54%

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Selective Use of Ultrasonography for the Detection of Pneumoperitoneum

Chen

2002

Academic Emergency Medicine

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Objective: Whether ultrasonography is superior to plain radiography for the detection of pneumoperitoneum is unknown. The goal of this study was to determine the value of ultrasonography for the detection of pneumoperitoneum. Methods: One hundred thirty-two patients with suspected hollow-organ perforation were prospectively selected for study. All 132 patients received ultrasonography, upright chest radiography, and left lateral decubitus abdominal radiography examinations. The diagnostic accuracies of chest and abdominal radiographs for the detection of pneumoperitoneum were compared with corresponding values from ultrasonography. Results: Of the 125 patients who underwent laparotomy, 121 patients had hollow-organ perforation, three patients had perforated appendicitis, and one patient had acute cholecystitis. For the diagnosis of pneumoperitoneum, ultrasonography demonstrated a sensitivity of 93%, a specificity of 64%, a positive predictive value of 97%, a negative predictive value of 44%, and an accuracy of 90%. Plain radiography revealed a sensitivity of 79%, a specificity of 64%, a positive predictive value of 96%, a negative predictive value of 21%, and an accuracy of 77%. Conclusions: Ultrasonography is a more sensitive diagnosing modality than plain radiography for the diagnosis of pneumoperitoneum. The authors suggest that ultrasonography was a useful diagnostic modality when plain radiographs failed to reveal pneumoperitoneum among patients with suspected hollow-organ perforation. Key words: hollow-organ perforation; free air; pneumoperitoneum; ultrasonography. ACADEMIC EMERGENCY MEDICINE 2002; 9:643-645. Pneumoperitoneum most commonly results from a perforated hollow viscus, or a gas-forming intraabdominal or retroperitoneal abscess. Upright chest radiography using a horizontal x-ray beam is a standard method in the detection of pneumoperitoneum.1 Plain radiography can demonstrate 55% to 85% of patients with pneumoperitoneum. 2,3However, diagnosis based on this method has practical limitations. Because many patients are too sick or debilitated to stand for chest radiographic examinations, a left lateral decubitus (LLD) abdominal radiograph may also be used to attempt to demonstrate pneumoperitoneum.Ultrasonography has been widely used in the evaluation of the patient with an acute abdomen. 4,5 Although ultrasonography can detect pneumoperitoneum, the relative sensitivity and specificity of ultrasonography for this task remain unclear. We hypothesized that ultrasonography is superior to plain radiography for the detection of pneumoperitoneum. This study was done to compare plain radiography with ultrasonography for the diagnosis of pneumoperitoneum. METHODSStudy Design. This was a prospective clinical investigation of the accuracy of ultrasound in the detection of pneumoperitoneum.Study Setting and Population. From March 1996 to March 1999, 132 patients with suspected holloworgan perforation were prospectively included in this study. Suspected hollow-organ perforation was defined as peptic ...

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Section: Limitationssupporting

confidence: 54%

“…4,5 Although ultrasonography can detect pneumoperitoneum, the relative sensitivity and specificity of ultrasonography for this task remain unclear. We hypothesized that ultrasonography is superior to plain radiography for the detection of pneumoperitoneum.…”

Section: 3mentioning

confidence: 99%

Selective Use of Ultrasonography for the Detection of Pneumoperitoneum

Chen

2002

Academic Emergency Medicine

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“…Gastroduodenal perforations (51%) due to peptic ulcers were the major cause of peritonitis in our study similar to most studies from the eastern hemisphere. [4][5][6][7][8] However, Agarwal et al 9 and Dorarajan et al 10 found small bowel perforations more common in North India because of decreasing incidence of peptic ulcer. In the West and in developed countries, it is well known that large bowel perforations are more common.…”

Section: Discussionmentioning

confidence: 99%

Community acquired secondary bacterial peritonitis in a tertiary hospital of South India: an audit with special reference to peritoneal fluid culture

Vpm

Chandramaliteeswaran²,

Dharanipragadha³

et al. 2012

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“…A few authors have reported this to be the most common cause of peritonitis in their series [6][7][8][9][10], whereas the incidence in China and Thailand is quite low [11,12]. Typhoid fever and tuberculosis are the common causes of small bowel perforation in the developing countries, while in western countries non-infectious pathologies such as Crohn's disease and malignancy are predominant [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Free Perforation of Ileal Tubercular Ulcer- A Case Report and Literature Review

Islam¹

2015

Clin Microbiol

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Primary intestinal tuberculosis is unusual in North American, European and Caribbean countries. Its diagnosis is often surprising and differentiation from inflammatory bowel diseases is difficult. Intestinal perforation is an uncommon but potentially fatal complication of intestinal tuberculosis. There is no reported case of ileal tubercular ulcer perforation from the Caribbean. We present a 59 year old HIV negative patient presented with peritonitis with solitary perforation of terminal ileum. Histology revealed presence of Langerhan's cell with caseating granulomatous inflammation and culture grew acid fast bacilli. A subsequent Manteaux test was strongly positive. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and it is now over one year, the symptoms have not recurs back again. Keywords: Intestinal tuberculosis; Perforation Case ReportA 59 year old known diabetic, hypertensive male presented with 2/7 history of sudden peri-umbilical pain and vomiting. History revealed that the pain was of sudden onset, peri-umbilical, and aggravated by movement and relieved by lying flat. He had no fever, shortness of breath or night sweats. He denied any history of recent travel or contact with anyone infected with tuberculosis. On examination, he was ill looking, moderately dehydrated, tachycardic (pulse of 120 beat per minute) but his blood pressure and body temperature were within normal range. His abdomen was grossly distended with mild diffuse tenderness, mild guarding but no rebound tenderness. There were sluggish bowel sounds. Digital rectal examination was normal. The white blood cell count was elevated (15.5 × 10 3 /ul) and all other labs within normal limit. Erect chest X-rayrevealed no free air however, a CT scan of abdomen and pelvis with intra-venous contrast revealed free air and free fluid in abdomen. After resuscitation patient was prepared for exploratory laparotomy which revealed a solitary 0.5 to 0.8 cm transverse perforation in the anti-mesenteric border of terminal ileum (Figure 1). There was no evidence malignancy or inflammatory bowel diseases (IBD). There was 200 mls of pus-like fluid in peritoneal cavity with inter-loop abscesses with pus flakes and exudates throughout. Segmental resection and primary anastomosis was performed. Patient had a good post op recovery. His ELISA Test for HIV was negative and serum ESR level was elevated. The chest xray showed no radiological evidence of pulmonary tuberculosis. The tuberculin skin test (Manteaux) was done on post-op day #5. It was strongly positive. Microscopic examination of the ileum revealed trans-mural perforation with presence of Langerhan's cell with caseating granulomatous inflammation consistent with small bowel tuberculosis. Acid fast bacilli stain confirmed the presence of Mycobacterium. The patient was started on anti-tubercular therapy (isoniazid, ethambutol, rifampicin). At one year follow up, he remains symptom free (Figure 2a and 2b).

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Accuracy of Ultrasonography in the Diagnosis of Peritonitis Compared With the Clinical Impression of the Surgeon

Cited by 23 publications

References 21 publications

Selective Use of Ultrasonography for the Detection of Pneumoperitoneum

Selective Use of Ultrasonography for the Detection of Pneumoperitoneum

Community acquired secondary bacterial peritonitis in a tertiary hospital of South India: an audit with special reference to peritoneal fluid culture

Free Perforation of Ileal Tubercular Ulcer- A Case Report and Literature Review

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