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Applied radiological anatomy of the peritoneal cavity
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
Intraperitoneal abscesses may form secondary to peptic ulcer disease, appendicitis or pancreatitis, or postoperatively, following gastric, biliary, or colonic surgery. Following bacterial contamination of the peritoneal cavity, focal collections are most common at the sites of maximum fluid stasis, especially the pelvis, the hepatorenal recess (Morison’s pouch), and right subphrenic space.
Ascites and Peritonitis
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Candi Jump, Douglas Moote, Wael N. Sayej
Ultrasound remains the most sensitive imaging for the detection of ascites. Fluid is easily detectable in the dependent areas of the hepatorenal recess and the pelvic cul-de-sac. Abdominal ultrasound can also aid in differentiating ascites from obesity, can look for signs of portal hypertension, such as an enlarged spleen or portal vein, and can assess hepatic vasculature flow with Doppler imaging. Computed tomography is a sensitive method to evaluate for ascites, but because of the risk of radiation exposure, it is only indicated when further information is needed such as in intraperitoneal bleeding. Magnetic resonance imaging (MRI) can also be used as a modality to detect ascites and has the benefit of no radiation exposure, but it can require sedation in young children secondary to the length of the examination as well as the associated sound of the MRI.
Pediatric abdominal trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Lauren Gillory, Bindi Naik-Mathuria
Ultrasound is the second most commonly used imaging modality in the trauma population and focused abdominal sonography for trauma (FAST) is a widely accepted tool in the management of adults. To conduct a FAST, four views are obtained using a bedside ultrasound: the perisplenic or splenorenal space, perihepatic or hepatorenal recess (Morrison’s pouch), pelvic, and pericardial view (Figure 18.2). The strength of this examination is in the detection of free fluid in locations that can affect management or identify a source of hemodynamic instability. For pediatric patients, FAST is more controversial and not as widely utilized. Original research in the field indicated a relatively high number of missed intra-abdominal injuries in the pediatric population, especially when there was an absence of free intraperitoneal fluid [16]. A recent article from Menaker et al. indicates that appropriate ultrasound exams could restrict abdominal CT use in normotensive pediatric trauma patients. The prospective observational study conducted using data from 12 emergency departments across the United States reported that FAST exams were obtained for only 887 patients (13.7%) of 6468 who met eligibility [17]. Analysis of the results revealed that patients with low or moderate risk of intra-abdominal injury as judged by the treating physicians (1%–5% and 6–10%, respectively) were less likely to receive an abdominal CT scan if a FAST was performed. The study did not identify any missed injuries in the patient population. Although other investigators have identified a low sensitivity for FAST in the setting of pediatric trauma [18], further studies have shown that combining FAST with careful physical examination increased the sensitivity to 88% [19]. Combining FAST with laboratory values indicative of intra-abdominal injury, such as liver transaminases, also exhibits an increased sensitivity [20]. Specifically, FAST can serve as a rapid diagnostic tool in the trauma bay when a hemodynamically unstable patient may not be suitable for transfer to the CT scanner. Ultrasound has potential for improving the examination of pediatric trauma patients and limiting CT use, but more advances in its implementation are necessary.
Strangulated internal hernia following severe ovarian hyperstimulation syndrome: a case report
Published in Gynecological Endocrinology, 2021
Likun Wei, Yanfang Zhang, Xueru Song
Her height was 165 cm and she weighed 70 kg. On admission, her temperature was 36.6 °C, blood pressure was 120/65 mmHg, heart rate was 110 beats/min, and oxygen saturation was 99%. Her abdomen was distended (abdominal girth, 91 cm), and shifting dullness was positive. A slight abdominal tenderness in the right upper abdomen was reported. Blood laboratory tests showed hemoconcentration (hematocrit, 42%; hemoglobin, 146 g/L), leukocytosis (white blood cells [WBC], 14.44 × 109/L; neutrophils, 79.6%), and hypoalbuminemia (serum albumin, 28 g/L). Her serum β-hCG level was 1378 IU/L and D-Dimer level was 1443 ng/ml, and renal function was normal. Pelvic ultrasound revealed a normal-sized uterus, bilateral ovarian enlargement (right ovary: 7.1 cm × 8.9 cm × 10.0 cm; left ovary: 6.6 cm × 4.0 cm × 7.0 cm) and large free fluid in the abdominal cavity (The depth of the right iliac fossa fluid was 8.6 cm, and the left was 5.4 cm. The depth of the Douglas pouch fluid was 2.3 cm, and a great quantity of fluid accumulated around the liver, spleen, and hepatorenal recess). Moreover, small amounts of left pleural effusion measuring 5.8 mm was detected in the patient. She was diagnosed with severe OHSS in early pregnancy, and was admitted to a hospital.