The value of ultrasound in diagnosis of pneumoperitoneum in emergent or critical conditions: A meta-analysis

Abstract

Background: Hollow organs perforation is a life-threatening condition. Early diagnosis and emergent intervention are important. Bedside ultrasound may be an alternative diagnostic tool for this condition. Objective: The aim of this study was to explore the diagnostic value of ultrasound of pneumoperitoneum in emergent or critical conditions through meta-analysis. Methods: PubMed, EMBASE, and Cochrane Library were systematically searched for potential studies. Then, two reviewers performed the processes of study selection, data extraction, and quality assessment independently. Finally, diagnostic indexes were analyzed with STATA 12.0 software (Serial No. 40120519635). Results: A total of five studies with moderate to high quality were eligible for meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio and their 95% confidence interval were 0.91 (95% confidence interval = 0.86-0.94), 0.96 (95% confidence interval = 0.75-0.99), 22.05 (95% confidence interval = 3.10-156.96), and 0.10 (95% confidence interval = 0.07-0.15), respectively. The area under the summary receiver operating characteristic curve was 0.92 (95% confidence interval = 0.90-0.94). Conclusion: Abdominal ultrasound is a useful alternative tool in diagnosing of pneumoperitoneum. However, due to limited evidence, it is not yet indicated for routine clinical use.

Elderly man with abdominal pain

“…Point‐of‐care ultrasound serves as a useful tool that can be performed at the bedside for rapid diagnosis. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for pneumoperitoneum diagnosed by ultrasound in emergent or critical conditions are 0.91, 0.96, 22.05, and 0.10, respectively 3 . The right upper quadrant is the most appropriate location for probe placement as the anterior aspect of the liver is not occupied by bowel content.…”

A Patient With Coronavirus Disease 2019 Pneumonia and Sudden Decompensation While Receiving Mechanical Ventilatory Support

“… 7 , 8 , 9 A meta-analysis evaluating the detection of pneumoperitoneum by ultrasound demonstrated a pooled sensitivity of 0.91. 10 Ultrasonography was shown to be superior to plain radiography in the detection of pneumoperitoneum in 188 patients with suspected hollow organ perforation. 11 Small amounts of free air appear as a localized echogenic area with posterior reverberation artifact.…”

The Use of Ceus Software with No Contrast Media Administration in the Diagnosis of Pneumoperitoneum

“…However, clinical diagnosis of the GI perforation site may be difficult, as symptoms may be non-specific (abdominal pain and distension, vomiting, constipation, fever, diarrhea, tachycardia, hypotension, and tachypnea) and related to multiple factors, including the source of the perforation and its mechanism, time elapsed since the perforation, the degree of contamination of the peritoneal cavity and the patient’s age [ 1 ]. In the emergency setting, radiology is vital in the early detection of this pathologic condition [ 6 ].…”

“…Other signs may include fluid abdominal effusion [ 12 ], inhomogeneous mesentery, wall thickening, “dirty mass” (extra-luminal fecal matter) [ 13 ], intestinal or porto-mesenteric pneumatosis, and abdominal abscess [ 8 , 14 ]. A total of 83–100% of PNP could be diagnosed through CT [ 6 ], although it is not cost effective and is associated with radiation exposure.…”

“…Ultrasound (US) findings of PNP were first identified in 1984 [ 15 ]. It has been profusely demonstrated that US could be useful in identifying PNP and investigating its causes [ 6 , 9 ], as reported in several studies and case reports [ 16 , 17 , 18 ], attesting to very different values of diagnostic accuracy (53–100%) [ 19 , 20 ].…”