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2017 ; 17
(68
): 30-35
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Is it possible to differentiate between pseudopneumoperitoneum and similar
pathologies ultrasonographically?
#MMPMID28439426
Smereczy?ski A
; Ko?aczyk K
J Ultrason
2017[Mar]; 17
(68
): 30-35
PMID28439426
show ga
AIM: The goal of the work was comparing gas ultrasound images below the right
diaphragm in two groups: in people with intestinal interposition below the
diaphragm and ones with pneumoperitoneum and extracting the traits
differentiating these two conditions. MATERIAL AND METHODS: Retrospectively, the
documentation of 22 patients with intestinal interposition below the diaphragm
(group 1) was utilized. Clinical material was used for comparison, previously
published, composed of 15 cases of pneumoperitoneum following laparotomy and of
14 cases following that symptom as a result of ulcer perforation - group 2 (in
total n = 29). Moreover, the distance in millimeters of the gas surface
reflecting ultrasounds from the parietal peritoneum was measured, the smoothness
of the surface, parietal peritoneum enhancement at the place of gas adherence,
gas continuity below the diaphragm with gas in the intestine located below the
liver. RESULTS: Direct adherence of the gas surface to the diaphragm was observed
in 100% of the cases of emphysema, but in no cases of intestinal interposition.
Yet, in the group of patients with colonic interposition (n = 21) there was
always a small gap (2-3 mm) and the gas surface among those patients in 100% of
the cases was uneven. CONCLUSIONS: In differentiation between pneumoperitoneum
and liver-diaphragm interposition of the intestine one should take into account -
apart from gas movement below the diaphragm at body position changing - the
presence of protrusion and section enhancement of the diaphragmatic peritoneum as
well as the distance of the gas from the diaphragm, the smoothness of its surface
and the continuity with the intestine below the liver. Interpositions of small
diaphragm-liver penetration may subside in erect position.