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      Accuracy of sonographic diagnosis of pneumoperitoneum using the enhanced peritoneal stripe sign in beagle dogs

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          Abstract

          The objective of this study was to evaluate the feasibility and accuracy of estimating the smallest amount of abdominal free gas detectible in a large population of beagles by ultrasonography. Healthy dogs were randomly divided into three groups: group A that received 0.1 mL of air injected into the peritoneal cavity, group B that received 0.2 mL of air injected into the peritoneal cavity, and group C that received 0.5 mL of intraperitoneal air. Randomly, some dogs in each group did not receive air injection for the negative control. All ultrasonographic procedures were performed by individuals blinded to group assignments and the presence of intraperitoneal air. The minimum volume of consistently detectable air with good accuracy and reliability was 0.2 mL. Results of the study demonstrated that the enhanced peritoneal stripe sign (EPSS) can verify cases of pneumoperitoneum if more than 0.2 mL of intra-abdominal free gas is present The EPSS is a reliable and specific ultrasonographic characteristic for diagnosing pneumoperitoneum in dogs.

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          Prevalence and duration of postoperative pneumoperitoneum: sensitivity of CT vs left lateral decubitus radiography.

          J Earls, Evelyn M. Molloy, Emilee E Colón-Lorenzo … (1993)
          The purpose of this study was to evaluate the prevalence, location, and duration of pneumoperitoneum in postoperative patients and to compare the sensitivities of CT and left lateral decubitus radiography in the detection of postoperative pneumoperitoneum. Twenty-seven CT scans and 27 abdominal radiographs with the patient in the left lateral decubitus position were obtained prospectively in 17 patients after uncomplicated abdominal surgery. Fifteen patients were examined 3 days after surgery and 12 were examined 6 days after surgery. The studies were evaluated in a blinded fashion for the presence, location, and volume of free air. The presence of air on the radiographs and the presence and quantity of air on the CT scans were correlated with each subject's surgical procedure, age, sex, and body habitus. Pneumoperitoneum was seen on 13 (87%) of 15 CT scans and eight (53%) of 15 radiographs obtained 3 days after surgery and on six (50%) of 12 CT scans and one (8%) of 12 radiographs obtained 6 days after surgery. The calculated volume of free air seen on the CT scans ranged from 0.3 to 5.8 ml. Sixty-two percent of collections by volume were located in the midline/parahepatic space, 22% in the pelvis, and 16% in the mesentery. Radiographs showed pneumoperitoneum in only nine (47%) of 19 examinations in which the corresponding CT scans showed free air. Findings on radiographs were false-negative in seven (87%) of eight obese patients in whom pneumoperitoneum was detected on CT scans. The prevalence of pneumoperitoneum in the postoperative period based on CT findings is greater than that previously reported. Small amounts of pneumoperitoneum frequently collect along the anterior abdominal wall in two preferential spaces, the pararectus and midrectus recesses. The results of this study show that CT is significantly more sensitive than plain radiography for detecting small amounts of free intraperitoneal air in postoperative patients. Radiography is particularly insensitive for imaging obese and heavy patients.
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            US of the peritoneum.

            Anthony Hanbidge, Deirdre Lynch, Stephanie Wilson (2003)
            Familiarity with the pathophysiology of peritoneal disease is the basis of successful ultrasound (US) study of the peritoneum. The pouch of Douglas, diaphragmatic surfaces, the paracolic gutters, and the regions of the mesentery and omentum should receive careful scrutiny in the patient at risk for a peritoneal disease process. An optimal US technique requires assessment of the entire peritoneum with a transducer selected to reflect the depth of the region of interest. US may demonstrate minute quantities of free intraperitoneal fluid and is therefore capable of providing sensitive quantitative information about ascites. Qualitative information may also be inferred, as blood, pus, and neoplastic cells demonstrate correlation with particulate ascites on gray-scale US scans. Peritoneal nodules, plaques, and thickening may be detected on the visceral or parietal peritoneal surfaces, especially when high-frequency probes are used. Transvaginal study in women increases the sensitivity of US for detection of peritoneal disease. In women who have unexplained sepsis or are at risk for carcinomatosis, transvaginal scanning should routinely be added to the regular abdominal and pelvic studies regardless of the findings of those studies. Peritoneal carcinomatosis, primary peritoneal neoplasms, pseudomyxoma peritonei, and peritonitis have characteristic appearances at US.
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              A specific sign of pneumoperitoneum on sonography: enhancement of the peritoneal stripe.

              Brendan Burns, Jonathan Simpson, Peter Wilson … (1999)
              Failure to reveal pneumoperitoneum is a recognized weakness of abdominal sonography. Our objective is to describe a reliable and reproducible sign of pneumoperitoneum that was first identified in an animal model and then confirmed in patients who had undergone laparoscopy. We injected 300 ml of degassed water into the peritoneal cavity of a 15-kg anesthetized pig. Sonographic images were obtained of the anterior peritoneal area after intraperitoneal injection of a single bubble, a series of bubbles, and, subsequently, a 10-ml bolus of air. Later, abdominal sonography was performed in nine patients who had undergone laparoscopy. Close attention was paid to the anterior peritoneal area and signs of free air observed in the animal model. Ten healthy volunteers functioned as a control group. In the pig, minute amounts of intraperitoneal air showed on sonography as enhancement of the peritoneal stripe. Larger volumes of intraperitoneal air showed as enhancement of the peritoneal stripe associated with dirty shadowing or distal multiple reflection artifacts. The stripe enhanced each time it appeared in the reflection artifact. Intraluminal gas was associated with a normal thin peritoneal stripe, superficial and distinct from the underlying gas artifact. The patients who had undergone laparoscopy showed findings suggestive of small and large pockets of free air, as we saw in the pig model. The control group showed findings consistent with intraluminal gas only. On sonography, enhancement of the peritoneal stripe alone or with reflection artifacts involving the peritoneal stripe is an accurate sign of pneumoperitoneum.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Vet Sci
                Journal ID (iso-abbrev): J. Vet. Sci
                Journal ID (publisher-id): JVS
                Title: Journal of Veterinary Science
                Publisher: The Korean Society of Veterinary Science
                ISSN (Print): 1229-845X
                ISSN (Electronic): 1976-555X
                Publication date (Print): June 2014
                Publication date (Electronic): 16 June 2014
                Volume: 15
                Issue: 2
                Pages: 195-198
                Affiliations
                Research Institute of Life Sciences, Gyeongsang National University, Jinju 660-701, Korea.
                Author notes
                Corresponding author: Tel: +82-55-772-2356; Fax: +82-55-772-2330; lhc@ 123456gnu.ac.kr
                Article
                DOI: 10.4142/jvs.2014.15.2.195
                PMC ID: 4087220
                PubMed ID: 24136212
                SO-VID: d6821c71-e9b0-4baf-93d0-4aa4fe5cbeeb
                Copyright © © 2014 The Korean Society of Veterinary Science.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 March 2013
                Date revision received : 05 July 2013
                Date accepted : 14 August 2013
                Funding
                Funded by: Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology
                Award ID: 2010-0007394
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Veterinary medicine
                Keywords: dog,enhanced peritoneal stripe sign,pneumoperitoneum,ultrasonography
                Data availability:
                ScienceOpen disciplines: Veterinary medicine
                Keywords: dog, enhanced peritoneal stripe sign, pneumoperitoneum, ultrasonography

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