Radiographic Look-Alikes: Distinguishing Between Pneumoperitoneum and Pseudopneumoperitoneum

Czy ultrasonograficznie można odróżnić pseudopneumoperitoneum od podobnych patologii?

“…In the case it is possible to diagnose interposition of the intestine certainly, based on clinical data and then imaging, it should be determined whether it is only a sign, or Chilaiditi syndrome, which sometimes may lead to serious consequences (1, 6, 11, 22, 23) . Even asymptomatic intestinal interposition in such a place may hinder conducting colonoscopy and constitutes a contraindication to perform biopsy of the liver in a typical manner (1–3, 6, 7, 22, 24) . The presence of disturbing abdominal symptoms may also take place as an expression of intestinal interposition following endoscopic examination, e.g.…”

“…Sometimes, in order to account for this phenomenon, it is imperative to perform computed tomography which resolves the issue best (1, 2) . Taking into consideration all the benefits of ultrasonography, including examination in emergency and in extremely difficult conditions, it is worth determining whether the method enables one to differentiate between pneumoperitoneum and simulating conditions, namely between pneumoperitoneum and pseudopneumoperitoneum (3–5) . The last term covers mainly unusual location of the intestine between the diaphragm and the liver, which in literature is termed the Chilaiditi sign (named after the surname of the author of the first publication on the subject matter).…”

Right upper-abdominal pain in a 97-year-old

“…2 Predisposing factors include an atrophic liver, laxity of the hepatic or the transverse colon suspension liga- uPPer abdominal Pain ment, abnormal fixation of the mesointestine, and diaphragmatic weakness. Other factors include advanced age; a history of abdominal surgery, adhesion, or intestinal obstruction 3 ; chronic lung disease; and cirrhosis. 4 Management is usually conservative, with a prokinetic agent or enema for constipation, and bed-rest or bowel decompression as needed, unless complications occur.…”

The acute abdomen

“…An exam favourite is Chilaiditi's syndrome, caused by a loop of bowel (usually transverse colon) between the liver and the diaphragm, which has the appearance of gas under the right hemidiaphragm. 20 4 What immediate management should be implemented for this patient?…”