Diffuse peritonitis (generalized peritoneal inflammation)

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Diffuse peritonitis

Diffuse peritonitis ultrasound case study

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Reporting Panel

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Peritoneal Pathology

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Diffuse peritonitis ultrasound case study

CASE–1

Clinical History

A 52-year-old patient presented with severe diffuse abdominal pain, abdominal distension, fever, nausea, vomiting, and generalized abdominal tenderness with guarding. The patient was referred for abdominal ultrasound to evaluate suspected generalized peritoneal inflammation and exclude intra-abdominal collections or bowel perforation.

Ultrasound Findings

Ultrasound examination demonstrates diffuse thickening and increased echogenicity of the peritoneal lining throughout the abdomen with generalized inflammatory changes involving the mesenteric fat. Mild diffuse free intraperitoneal fluid is present between bowel loops and within the pelvis. Multiple bowel loops demonstrate mild reactive wall thickening with preserved mural stratification. No localized abscess, bowel obstruction, or definite pneumoperitoneum is identified on the current examination. Color Doppler demonstrates increased vascularity of the inflamed peritoneum and adjacent mesentery.

Ultrasound of the abdomen. Diffuse thickening and increased echogenicity of the peritoneal lining with generalized mesenteric inflammatory changes and small-volume free intraperitoneal fluid. These sonographic findings are suggestive of diffuse peritonitis (generalized peritoneal inflammation).

Report Line

Diffuse thickening and increased echogenicity of the peritoneal lining are demonstrated throughout the abdomen with generalized inflammatory changes involving the mesenteric fat. Moderate free intraperitoneal fluid is noted between bowel loops and within the pelvis. Mild reactive bowel wall thickening is present without evidence of localized abscess, bowel obstruction, or definite pneumoperitoneum on the current examination. Sonographic findings are suggestive of diffuse peritonitis.

Impression

Features are suggestive of diffuse peritonitis (generalized peritoneal inflammation) with associated mild free intraperitoneal fluid and diffuse mesenteric inflammatory changes. No localized intra-abdominal abscess is identified on the current examination.

Recommendation

Urgent clinical and surgical evaluation is recommended. Correlation with laboratory investigations including CBC, CRP, ESR, serum lactate, blood cultures, and renal function tests is advised. Contrast-enhanced CT abdomen and pelvis should be performed to determine the underlying cause and evaluate for bowel perforation, ischemia, abscess, or other intra-abdominal pathology. Prompt treatment should be initiated based on the clinical diagnosis.

Key Learning Points

• Diffuse peritonitis represents generalized inflammation of the peritoneal cavity and is a potentially life-threatening condition.
• Ultrasound may demonstrate diffuse peritoneal thickening, increased echogenicity of the mesenteric fat, free intraperitoneal fluid, and reactive bowel wall thickening.
• Color Doppler often shows increased vascularity of the inflamed peritoneum and adjacent mesentery.
• Common causes include bowel perforation, severe intra-abdominal infection, postoperative peritonitis, pancreatitis, pelvic inflammatory disease, tuberculosis, and peritoneal dialysis-related infection.
• Ultrasound is useful for detecting free fluid and inflammatory changes but has limited sensitivity for identifying the exact source of peritonitis.
• Contrast-enhanced CT is the imaging modality of choice for determining the underlying cause, disease extent, and associated complications.
• Diffuse peritonitis requires urgent medical and often surgical management because delayed treatment is associated with significant morbidity and mortality.