Free intraperitoneal gas from non-traumatic perforated viscus

Case contributed by Dr Edward Zhong

Presentation

Sudden onset epigastric abdominal pain with associated vomiting. Previous cholecystectomy and pancreatitis.

Patient Data

Age: 88 years
Gender: Female

The notable finding is a substantial amount of free intraperitoneal gas, mainly located anteriorly in the upper abdomen and most prominent in the right upper outer quadrant where it extends into the perihepatic spaces and hepatic fissures. In the absence of any history of recent surgical intervention, this would indicate recent rupture of a hollow viscus. There is substantial bowel wall thickening in the mid abdomen which most likely is located in the transverse colon extending proximally to reach the hepatic flexure region. Mottled gas in relation to the left side of the transverse colon may be intraluminal but could indicate extraluminal gas within the transverse mesocolon. Mild diverticular disease is noted in the sigmoid colon. No other abnormality is evident in relation to the bowel or peritoneal cavity. There is no evidence of free intraperitoneal fluid.

Conclusion:

The finding of note is a substantial amount of free intraperitoneal gas which would indicate recent rupture of a hollow viscus and is most likely related to pathology in the transverse colon.  

Case Discussion

Patient underwent emergency laparotomy which repaired a large perforation of the distal transverse colon into the lesser sac.

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Case information

rID: 52538
Case created: 11th Apr 2017
Last edited: 23rd Apr 2017
Inclusion in quiz mode: Included

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