Secondary peritonitis CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]

Overview

CT may be positive in unto 82%. CT may be indicated in all patients with acute abdomen. However, CT can be omitted when a diagnosis is made according to the results of precedent examinations such as US. Radiation exposure should be considered with the use of CT.

Key CT Findings in Secondary peritonitis

• Contrast-enhanced CT is useful in identifying an intraabdominal source for infection.
• If the diagnosis of peritonitis is made clinically, a CT scan is not necessary and generally delays surgical intervention without offering clinical advantage.
• However, CT scanning is indicated in all cases in which the diagnosis cannot be established on clinical grounds and findings on abdominal plain films.
• CT scans of the abdomen and pelvis remain the diagnostic study of choice for peritoneal abscess and related visceral pathology.
• Whenever possible, the CT scan should be performed with enteral and intravenous contrast.
• CT scans can detect small quantities of fluid, areas of inflammation, and other GI tract pathology, with sensitivities that approach 100%.
• CT scanning can be used to evaluate for ischemia, as well as to determine bowel obstruction.
• An abscess is suggested by the presence of fluid density that is not bound by the bowel or other known structures.
• Gas within an abdominal mass or the presence of an enhancing wall and adjacent inflammatory changes are also highly suggestive of an abscess.
• Ischemia can be demonstrated by a clot in a large vessel or by the absence of blood flow.
• Gas within the intestinal wall or in the portal vein may also suggest ischemia.
• Enhanced CT is recommended for the evaluation of organ ischemia, vascular lesions, or acute pancreatitis severity.
• CT has high diagnosability for intestinal ischemia, gastrointestinal perforation, acute appendicitis, diverticulitis, biliary tract calculus, and acute pancreatitis among others. However, these diseases cannot be completely ruled out, even if abnormalities are not found on CT.
• In patients taking a biguanide for diabetes, attention must be paid to the potential onset of lactic acidosis after iodinated contrast media administration .
• CT is also recommended for detecting intra-abdominal free air.