New ultrasonic finding in perforated ulcer

Preoperative sonographic diagnosis of sealed-off perforated gastric ulcer

“…In addition to pneumoperitoneum, some indirect sonographic findings that can help detect PPU have been reported 2,5,[15][16][17] ; these include subphrenic or subhepatic fluid accumulations, debris or fluid accumulation in the gastrohepatic recess, thickening of the gallbladder walls (> 4 mm), an inflammatory mass in the upper abdomen, focal thickening (> 7 mm) and deformity of the walls of the gastric antrum or duodenal bulb, and a dilated, atonic, fluid-filled stomach. None of these findings is specific to PPU.…”

“…Classically, its diagnosis is based on clinical presentation, history, and, most important, the demonstration of pneumoperitoneum, usually by radiography. However, x-ray studies are negative in about a third of patients with PPU, [1][2][3][4][5] and sonography is negative in a quarter of patients. 2 Moreover, the presence of free air is not a specific sign of PPU.…”

Diagnosis of Perforated Gastric Ulcers by Ultrasound

“…Lying on the left side, free air can be demonstrated between lateral abdominal wall and liver [9] or in the subhepatic region [10].…”

“…Indirect sonographic signs of perforated ulcers are particularly helpful to locate possibly perforated or sealed-off perforated ulcers and are usually present in the environment of perforated ulcers. An inflammatory or oedematous mass in the upper abdomen or a dilated, atonic, fluid-filled stomach might be observed [10,15]. The sonographical detection of an inflammatory mass in the stomach and duodenum is generally possible by following the gastrointestinal tract up and down, whereas it might sometimes be difficult to distinguish between stomach and duodenum.…”

Confined gastric perforation: Ultrasound and computed tomographic diagnosis

“…The visualization of leakage of gastric content--sonographically characterized by multiple patchy reflections in a peritoneal fluid collect i o n -i s a pathognomonic sign of gastrointestinal perforation [2,3,8]. An extraluminal localized area of high echogenicity in the subhepatic region associated with peritoneal fluid is a common finding in perforated peptic ulcers [4]. In a confined perforation, small locules with fluid and "trapped air" can be found [8].…”