Preoperative detection of closed perforation of the small intestine by ultrasonography
Journal
Journal of Medical Ultrasound
Journal Volume
7
Journal Issue
3
Pages
163-166
Date Issued
1999
Author(s)
Abstract
The diagnosis of small intestinal perforation is difficult. Clinical manifestations are subtle and non-specific. If the perforation is sealed by the greater omentum or adjacent peritoneal folds, the patient may appear surprisingly well and exhibit no signs of peritonitis. Extraluminal air, the radiographic hallmark of a perforated hollow viscus, may be invisible in most cases of closed small intestinal perforation. Absence of peritoneal signs and free air on imaging studies may confuse the diagnosis. Mortality and morbidity rates after delayed diagnosis of intestinal perforation are high. Ultrasonography is commonly the first imaging modality used to evaluate patients with acute abdominal symptoms. We present a 67-year-old man with left upper quadrant pain whose ultrasonographic survey revealed a segmental asymmetric thickening of the bowel wall with surrounding creeping fat and an extruding hypoechoic lesion adjacent to the nearby small bowel segment. A preoperative diagnosis of closed small intestinal perforation was made and the patient underwent immediate surgery. A hole was found at the jejunum and an uneventful postoperative course followed resection. The importance of ultrasonography in the preoperative diagnosis of closed small intestine perforation is emphasized.
SDGs
Other Subjects
aged; article; case report; echography; human; peritonitis; preoperative evaluation; small intestine perforation
Publisher
Elsevier (Singapore) Pte Ltd
Type
journal article