[Clinical relevance of sonography in acute diagnosis of perforated gastroduodenal ulcers]

Sonographic diagnosis of a small fistulous communication between a subphrenic abscess and a perforated duodenal ulcer

We report a case of a fistula between a subphrenic abscess and a perforated duodenal ulcer diagnosed by sonography and confirmed by CT. The sonographic findings included a subphrenic fluid collection connected to the anterior aspect of the superior duodenum by a nonpulsatile, anechoic tubular lesion. Manual compression of the upper epigastrium resulted in movement of echogenic debris from the antrum and superior duodenum through the fistulous tract into the abscess.

Detection of pneumoperitoneum by ultrasound examination: an experimental and clinical study

PURPOSE OF THE STUDY

The aim of the study is to show the value and reliability of ultrasound examination in detecting free intraabdominal air after blunt abdominal trauma.

METHODS

The experimental part of this study includes the evaluation of the sonographic morphology of air within liquid and solid tissues. Subsequently air was injected into the abdominal cavities of 10 cadavers and sonography utilized for localization and assessment of the minimal detectable air volume. The clinical part of the study reports on the sonographic detection of hollow viscus perforation in 10 patients, who were admitted to our institution because of acute abdominal problems.

RESULTS

Sonography is a reliable method for the diagnosis of free intraabdominal air. Best position for ultrasound examination of the abdomen is supine with the thorax slightly elevated (10-20 degrees). The optimal probe position is in the right paramedian epigastric area in the longitudinal direction. In all the 10 patients we were able to diagnose pneumoperitoneum preoperatively by ultrasound assessment.

Confined gastric perforation: ultrasound and computed tomographic diagnosis

A case of confined gastric perforation due to a penetrating antral ulcer diagnosed on ultrasound and computed tomography is presented. Air bubbles were visualized adjacent to the anterior gastric and bulbar wall, associated with small amounts of fluid in the subhepatic region and in the omental bursa. Careful examination of the subhepatic region and upper abdominal cavity in a patient with acute epigastric pain may lead to a correct diagnosis of such confined perforations.