DYNAMIC EMERGENCY MEDICINE
Emergency Ultrasound Identification of Pneumoperitoneum
Article first published online: 8 MAR 2010
© 2010 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 18, Issue 3, page e30, March 2011
How to Cite
Stone, M. B. and Papanagnou, D. (2011), Emergency Ultrasound Identification of Pneumoperitoneum. Academic Emergency Medicine, 18: e30. doi: 10.1111/j.1553-2712.2010.00671.x
- Issue published online: 8 MAR 2010
- Article first published online: 8 MAR 2010
A 72-year-old man with a medical history of hypertension and gastrointestinal bleeding presented to the emergency department (ED) with abdominal pain, coffee ground emesis, and weakness that began 3 hours prior to arrival. Vital signs were blood pressure 82/44 mm Hg, pulse 118 beats/min, respirations 22 breaths/min, temperature 97.2°F, and oxygen saturation 94% while breathing room air. Physical examination revealed mild respiratory distress and diffuse abdominal tenderness with guarding and rebound.
During the initial stabilization of the patient, an upright portable chest radiograph was obtained (Figure 1) but did not demonstrate evidence of pneumoperitoneum. Given the high suspicion for pneumoperitoneum, a bedside focused assessment with sonography in trauma (FAST) ultrasound examination was performed by the treating emergency physician using a low-frequency 5–2 MHz curvilinear transducer (SonoSite MTurbo, Bothell, WA). This demonstrated free intraperitoneal fluid in Morison’s pouch (Video Clip S1). Upon attempting views of the pelvis, distinct hyperechoic foci with reverberation artifacts were visualized within the free fluid, suggesting associated free intraperitoneal air (Video Clip S2). Surgical consultation was immediately obtained and a noncontrast computed tomography exam of the abdomen and pelvis was performed, confirming free intraperitoneal fluid and pneumoperitoneum (Figure 2). The patient was taken emergently to the operating room, where a large posterior gastric perforation was identified and repaired.
Video Clip S1. Free intraperitoneal fluid in Morison’s pouch
Video Clip S2. Distinct hyperechoic foci with reverberation artifacts were visualized within the free fluid, suggesting associated free intraperitoneal air
The video clips are in QuickTime.
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|ACEM_671_sm_VideoClipS2.mov||3152K||Supporting info item|
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