Skip to main content

Imaging of Nontraumatic Abdominal Wall and Peritoneal Emergencies

  • Living reference work entry
  • First Online:
Atlas of Emergency Imaging from Head-to-Toe

Abstract

Nontraumatic abdominal wall and peritoneal emergencies comprise a spectrum of conditions ranging from those that are self-limiting and managed conservatively, to others which are potentially life-threatening and require immediate, multi-specialty levels of care and intervention. Imaging, particularly computed tomography (CT), plays an essential role in the care of patients with a suspected nontraumatic abdominal wall or peritoneal emergency. Nontraumatic emergencies of the abdominal wall include complications associated with hernias, abdominal wall fluid collections, and soft-tissue necrotizing infections (fasciitis), fistulas from the gut to the abdominal wall, rectus sheath hematomas, and complications associated with indwelling medical devices or catheters. Nontraumatic peritoneal emergencies include peritonitis, hemoperitoneum, pneumoperitoneum, peritoneal carcinomatosis, epiploic appendagitis, omental infarction, mesenteric adenitis, and mesenteric panniculitis. The emergency radiologist must be familiar with the imaging appearance of the abdominal wall and peritoneal emergencies, to help guide clinical management of these patients by establishing a diagnosis and identifying any potential complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Matalon SA, Askari R, Gates JD, Patel K, Sodickson AD, Khurana B. Don’t forget the abdominal wall: imaging spectrum of abdominal wall injuries after nonpenetrating trauma. Radiographics. 2017;

    Google Scholar 

  2. Ballard DH, Mazaheri P, Oppenheimer DC, Lubner MG, Menias CO, Pickhardt PJ, et al. Imaging of abdominal wall masses, masslike lesions, and diffuse processes. Radiographics. 2020;

    Google Scholar 

  3. Aguirre DA, Santosa AC, Casola G, Sirlin CB. Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT. In: Radiographics; 2005.

    Google Scholar 

  4. Mirvis SE, Soto JA, Shanmuganathan K, Yu JKW. Problem solving in emergency radiology. Philadelphia: Elsevier; 2014. p. 428–31.

    Google Scholar 

  5. Macari M, Megibow A. Imaging of suspected acute small bowel obstruction. Semin Roentgenol. 2001;

    Google Scholar 

  6. Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-tissue infections and their imaging mimics: from cellulitis to necrotizing fasciitis. Radiographics. 2016;

    Google Scholar 

  7. Gossios K, Zikou A, Vazakas P, Passas G, Glantzouni A, Glantzounis G, et al. Value of CT after laparoscopic repair of postsurgical ventral hernia. Abdom Imaging. 2003;

    Google Scholar 

  8. Lacour M, Ridereau Zins C, Casa C, Venara A, Cartier V, Yahya S, et al. CT findings of complications after abdominal wall repair with prosthetic mesh. Diagn Interv Imaging. 2017;

    Google Scholar 

  9. Tonolini M, Magistrelli P. Enterocutaneous fistulas: a primer for radiologists with emphasis on CT and MRI. Insight Imaging. 2017;

    Google Scholar 

  10. Rakic S, Leblanc KA. The radiologic appearance of prosthetic materials used in hernia repair and a recommended classification. Am J Roentgenol. 2013;

    Google Scholar 

  11. Gavlin A, Kierans AS, Chen J, Song C, Guniganti P, Mazzariol FS. Imaging and treatment of complications of abdominal and pelvic mesh repair. Radiographics. 2020;

    Google Scholar 

  12. Childers BJ, Potyondy LD, Nachreiner R, Rogers FR, Childers ER, Oberg KC, et al. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg. 2002;

    Google Scholar 

  13. Ballard DH, Mazaheri P, Raptis CA, Lubner MG, Menias CO, Pickhardt PJ, et al. Fournier gangrene in men and women: appearance on CT, ultrasound, and MRI and what the surgeon wants to know. Can Assoc Radiol J. 2020;

    Google Scholar 

  14. Fukuda T, Sakamoto I, Kohzaki S, Uetani M, Mori M, Fujimoto T, et al. Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging. 1996;

    Google Scholar 

  15. Rimola J, Perendreu J, Falcó J, Fortuño JR, Massuet A, Branera J. Percutaneous arterial embolization in the management of rectus sheath hematoma. AJR Am J Roentgenol. 2007;

    Google Scholar 

  16. Brittenden J, Tolan DM. Radiology of the post surgical abdomen. Radiol Post Surg Abdom. 2013;

    Google Scholar 

  17. Carr CM, Jacob J, Park SJ, Karon BL, Williamson EE, Araoz PA. CT of left ventricular assist devices. Radiographics. 2010;

    Google Scholar 

  18. Levy AD, Shaw JC, Sobin LH. From the archives of the AFIP: secondary tumors and tumorlike lesions of the peritoneal cavity: Imaging features with pathologic correlation. Radiographics. 2009;

    Google Scholar 

  19. Jolles HCC. CT of ascites: differential diagnosis. Am J Roentgenol. 1980;135(2):315–22.

    Article  CAS  Google Scholar 

  20. Rudralingam V, Footitt C, Layton B. Ascites matters. Ultrasound. 2017;

    Google Scholar 

  21. Patlas MN, Alabousi A, Scaglione M, Romano L, Soto JA. Cross-sectional imaging of nontraumatic peritoneal and mesenteric emergencies. Can Assoc Radiol J. 2013;

    Google Scholar 

  22. Elsayes KM, Staveteig PT, Narra VR, Leyendecker JR, Lewis JS, Brown JJ. MRI of the peritoneum: spectrum of abnormalities. Am J Roentgenol. 2006;

    Google Scholar 

  23. Wallace AN, McConathy J, Menias CO, Bhalla S, Wippold FJ. Imaging evaluation of CSF shunts. Am J Roentgenol. 2014;

    Google Scholar 

  24. Furlan A, Fakhran S, Federle MP. Spontaneous abdominal hemorrhage: causes, CT findings, and clinical implications. Am J Roentgenol. 2009;

    Google Scholar 

  25. Gayer G, Hertz M, Manor H, Strauss S, Klinowski E, Zissin R. Dense ascites: CT manifestations and clinical implications. Emerg Radiol. 2004;

    Google Scholar 

  26. Orwig D, Federle MP. Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. Am J Roentgenol. 1989;

    Google Scholar 

  27. Federle MP, Pan KT, Pealer KM. CT criteria for differentiating abdominal hemorrhage: anticoagulation or aortic aneurysm rupture? Am J Roentgenol. 2007;

    Google Scholar 

  28. Lucey BC, Varghese JC, Anderson SW, Soto JA. Spontaneous hemoperitoneum: a bloody mess. Emerg Radiol. 2007;

    Google Scholar 

  29. Lubner M, Menias C, Rucker C, Bhalla S, Peterson CM, Wang L, et al. Blood in the belly: CT findings of hemoperitoneum. Radiographics. 2007;

    Google Scholar 

  30. Hertzberg BS, Kliewer MA, Paulson EK. Ovarian cyst rupture causing hemoperitoneum: Imaging features and the potential for misdiagnosis. Abdom Imaging. 1999;

    Google Scholar 

  31. Casillas VJ, Amendola MA, Gascue A, Pinnar N, Levi JU, Perez JM. Imaging of nontraumatic hemorrhagic hepatic lesions. Radiographics. 2000;

    Google Scholar 

  32. Gayer G, Jonas T, Apter S, Amitai M, Shabtai M, Hertz M. Postoperative pneumoperitoneum as detected by CT: prevalence, duration, and relevant factors affecting its possible significance. Abdom Imaging. 2000;

    Google Scholar 

  33. Borofsky S, Taffel M, Khati N, Zeman R, Hill M. The emergency room diagnosis of gastrointestinal tract perforation: the role of CT. Emerg Radiol. 2015;

    Google Scholar 

  34. Le O. Patterns of peritoneal spread of tumor in the abdomen and pelvis. World J Radiol. 2013;

    Google Scholar 

  35. Gore RM, Silvers RI, Thakrar KH, Wenzke DR, Mehta UK, Newmark GM, et al. Bowel obstruction. Radiol Clin N Am. 2015;

    Google Scholar 

  36. Neyman EG, Georgiades CS, Fishman EK. Abdominal involvement in tuberculosis. Emerg Radiol. 2002;

    Google Scholar 

  37. Singh AK, Gervais DA, Hahn PF, Sagar P, Mueller PR, Novelline RA. Acute epiploic appendagitis and its mimics. Radiographics. 2005;

    Google Scholar 

  38. Van Breda Vriesman AC, Mol D, van Otterloo AJC, Puylaert JBCM. Epiploic appendagitis and omental infarction. Eur J Surg. 2001;

    Google Scholar 

  39. Kamaya A, Federle MP, Desser TS. Imaging manifestations of abdominal Fat necrosis and its mimics. Radiographics. 2011;

    Google Scholar 

  40. Macari M, Hines J, Balthazar E, Megibow A. Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. Am J Roentgenol. 2002;

    Google Scholar 

  41. Lucey BC, Stuhlfaut JW, Soto JA. Mesenteric lymph nodes seen at imaging: causes and significance. Radiographics. 2005;

    Google Scholar 

  42. McLaughlin PD, Filippone A, Maher MM. The “misty mesentery”: mesenteric panniculitis and its mimics. Am J Roentgenol. 2013;

    Google Scholar 

  43. Gögebakan Ö, Albrecht T, Osterhoff MA, Reimann A. Is mesenteric panniculitis truely a paraneoplastic phenomenon? A matched pair analysis. Eur J Radiol. 2013;

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mohamed Z. Rajput .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Rajput, M.Z., Ballard, D.H. (2021). Imaging of Nontraumatic Abdominal Wall and Peritoneal Emergencies. In: Patlas, M.N., Katz, D.S., Scaglione, M. (eds) Atlas of Emergency Imaging from Head-to-Toe. Springer, Cham. https://doi.org/10.1007/978-3-030-44092-3_33-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-44092-3_33-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-44092-3

  • Online ISBN: 978-3-030-44092-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics