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Point-of-Care Ultrasound
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Carlos Augusto M. Menegozzo, Bruno M. Pereira
There are several situations in which point of care ultrasound can enhance the quality of care and safety of the patient, serving as an excellent triage tool for critical decisions in the RLE. Although these may be considered as ‘non-life-saving’ applications, POCUS may provide an objective assessment and help with the decision to urgently evacuate the patient to a more complex facility. In that sense, POCUS can provide the diagnosis of inflammatory conditions such as acute appendicitis, cholecystitis and diverticulitis, and intra-abdominal hypertension (IAH) in critical scenarios. Pneumoperitoneum may be identified using POCUS with a much higher accuracy than X-rays or physical signs. Patients with acute scrotal pain may be urgently operated on for a testicular torsion, based on ultrasound results. Signs of intestinal obstruction may be confirmed with a simple ultrasound scanning. Moreover, studies show that POCUS may be used for tube thoracotomies, airway access, and other interventional procedures.
Imaging Considerations in NEC Diagnosis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
In recent years, ultrasound (Figure 6.7c) has been shown to have similar or even greater sensitivity compared to XR for the detection of small and large volumes of pneumoperitoneum. Ultrasound findings of free air are highly associated with poor clinical outcomes of surgery or death (31). The precise clinical significance of ultrasound evidence of pneumoperitoneum that is not detectable by X-ray remains uncertain.
Vitellointestinal (omphalomesenteric) duct anomalies
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Meckel's diverticulitis is an unusual presentation in children. When it does occur, the child is assessed clinically as having acute appendicitis, but at laparotomy the appendix is found to be normal and there is an inflammatory process involving a Meckel's diverticulum. In all operations for suspected appendicitis in which the appendix is found to be normal at laparotomy or on laparoscopy, the distal 100 cm of ileum should be inspected to exclude inflammation of the Meckel's diverticulum as being responsible for the symptoms. The inflamed Meckel's diverticulum is often palpable in the abdomen on opening the peritoneum. An inflammatory mass around a Meckel's diverticulum may result from perforation of an ulcer in the ileum adjacent to the base of the diverticulum. Perforation may also cause pneumoperitoneum and peritonitis.
Visual Observation of Abdominal Adhesion Progression Based on an Optimized Mouse Model of Postoperative Abdominal Adhesions
Published in Journal of Investigative Surgery, 2023
Zijun Wang, Enmeng Li, Cancan Zhou, Bolun Qu, Tianli Shen, Jie Lian, Gan Li, Yiwei Ren, Yunhua Wu, Qinhong Xu, Guangbing Wei, Xuqi Li
It has been proven that CT with an artificial pneumoperitoneum is of great value in the diagnosis of PAAs [16]. Additionally, CT followed by three-dimensional reconstruction can provide a more intuitive basis for the diagnosis and treatment of PAAs. For these reasons, the evolution of PAAs in the brush group was observed using artificial pneumoperitoneum CT (Figure 4A). Interestingly, although the cecum was significantly more edematous on PODs 1 and 3 than in the control group, no adhesion bands were observed on CT on POD 1 or 3. Subsequently, images acquired on PODs 5, 7 and 14 showed that the intestines and organs were attached to the abdominal wall, implying the presence of adhesions. Then, we evaluated differences in the adhesion rate among these three points through three-dimensional reconstruction (Figure 3B–D and Figure S3B), and we found that the adhesion area was almost the same on PODs 5, 7 and 14, with a statistically significant difference in the adhesion area compared to the control group on all three days. In summary, while exploring the standardization process, we also identified two new noninvasive methods for visualizing PAA morphology in mice, reducing the abstraction of PAAs. Each of the two methods has advantages and can serve as a new in vivo imaging method for the observation of PAAs (Table 2).
The clinical toxicology of sodium hypochlorite
Published in Clinical Toxicology, 2019
Robin J. Slaughter, Martin Watts, J. Allister Vale, Jacob R. Grieve, Leo J. Schep
A 66-year-old woman ingested an unknown quantity of Clorox™ bleach (sodium hypochlorite 5.25%) in a suicide attempt [19]. She developed vomiting, a black tongue, CNS depression, slurred speech, hypotension (98/70 mmHg, which subsequently fell to 70 mmHg systolic), sinus tachycardia (107/min), and “shallow respirations”. The odor of bleach was on the breath. a metabolic acidosis (arterial blood pH 7.18, pCO2 19 mmHg [2.53 kPa], pO2 361 mmHg [48.1 kPa], bicarbonate 7 mmol/L) and hyperchloremic hypernatremia (chloride concentration 143 mmol/L; sodium concentration 169 mmol/L). Chest X-ray showed bilateral pneumothoraces, which required chest tube insertion and there was a collection of air in the abdomen suggestive of pneumoperitoneum. These radiological appearances strongly suggested perforation. Supportive care was provided but cardiopulmonary arrest occurred twice with the second incident not being responsive to resuscitation. Corrosive injury to the esophagus and stomach was present at post-mortem and the stomach was perforated at the esophagogastric junction.
Nonoperative management of pneumoperitoneum after colonoscopy
Published in Baylor University Medical Center Proceedings, 2018
Lana A. Joudeh, Megan G. Newman
Perforation rates in colonoscopies vary depending on the type of procedure being performed. The incidence of perforations ranges from 0.016% to 0.2% following diagnostic colonoscopies.1 Perforations lead to free air in the abdomen, a condition known as pneumoperitoneum. Although pneumoperitoneum is often suggestive of an overtly perforated viscus, it may also arise through microperforations or through transmural passage of air into the peritoneal cavity during colonoscopies.2 Pneumoperitoneum is a rare consequence of colonoscopies and poses a therapeutic dilemma to physicians, particularly if patients are asymptomatic. Pneumoperitoneum is generally thought to be a surgical emergency because it can lead to enteric contamination within the peritoneal cavity with subsequent peritonitis and sepsis.3 Here, we present a rare case of pneumoperitoneum that developed after colonoscopy.