The Acute Abdomen — Abscesses, Hematomas, and Postoperative Collections

  • Francis S. Weill


I will describe in this chapter the various ultrasonic abnormalities arising in the case of the clinical condition commonly called the “acute abdomen” or “abdominal emergency” (what is an emergency? for me it is a clinical condition requiring immediate diagnosis and treatment). Some of these abnormalities have already been studied in previous chapters, for instance acute cholecystitis and pancreatitis, or splenic infarcts. These will be dealt only briefly here. I will also set guidelines, clinical and technical, for assessing the acute abdomen, a process requiring a rapid and sure diagnosis, which for the experienced clinical ultrasound imager (can one aspire to be an imager without being a clinician? I don’t think so) represents the most challenging and rewarding part of his or her activity. The reputation of an ultrasound department, whether in a hospital or small clinic, depends to a large extent upon the quality of its emergency examinations.


Acute Appendicitis Acute Abdomen Sagittal Section Traumatic Lesion Black Arrowhead 
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References and Further Reading

  1. Abramson SJ, Berdon WE, Kaufmann RA et al. (1989) Hepatic parenchymal and subcapsular gas after hepatic laceration caused by blunt abdominal trauma. AJR 153:1031–1032PubMedGoogle Scholar
  2. Agha FP (1986) Intussusception in adults. AJR 146: 527–531PubMedGoogle Scholar
  3. Alessi V, Salerno G (1985) The “hay-fork” sign in the ultrasonographic diagnosis of intussusception. Gastrointest Radiol 10:177–179PubMedCrossRefGoogle Scholar
  4. Anderegg A, Rizzatto G (1985) Liver trauma: natural history and complications. 5 th World congress of ultrasound (WFUMB), July 1985, Sydney, abstract p 112Google Scholar
  5. Baker DE, Silver TM, Coran AG, McMillin KJ (1986) Postappendectomy fluid collections in children: incidence, nature, and evolution evaluated using US. Radiology 161:341–344PubMedGoogle Scholar
  6. Barakos JA, Brooke JR, Federle MP, Wing VW, Laing FC, Hightower DR (1986) CT in management of periappendiceal abscess. AJR 146:1161–1164PubMedGoogle Scholar
  7. Barnett E, Morley P (1974) Abdominal echography. Butterworths, Borough Green, EnglandGoogle Scholar
  8. Borushok KF, Brooke Jeffrey R, Laing FC et al. (1990) Sonographic diagnosis of perforation in patients with acute appendicitis. AJR 154: 275–278PubMedGoogle Scholar
  9. Bowerman RA, Silver TM, Jatte MH (1978) Real time ultrasound diagnosis of intussusception in children. Radiology 143: 527–529Google Scholar
  10. Bret PM et al. (1982) Une technique simple de guidage des ponctions percutanées par Péchographie en temps réel. J Radiol 63: 363–365PubMedGoogle Scholar
  11. Brooke-Jeffrey R, Laing FC, Wing VW (1986) Ultrasound in acute pancreatic trauma. Gastrointest Radiol 11:44–46CrossRefGoogle Scholar
  12. Brooke-Jeffrey R, Laing FC, Townsend RR (1988) Acute appendicitis — sonographic criteria based on 250 cases. Radiology 167: 327–329Google Scholar
  13. Bulas DI, Taylor GA, Eichelberger MR (1989) The value of CT in detecting bowel perforation in children after blunt abdominal trauma. AJR 153: 561–564PubMedGoogle Scholar
  14. Dachman AH, Nichols JB, Patryck DH, Lichtenstein JE (1987) Natural history of the obstructed rabbit appendix. AJR 148:281–284PubMedGoogle Scholar
  15. Doust BD, Doust VL (1976) Ultrasonic diagnosis of abdominal abscesses. Am J Dig Dis 21:569–576PubMedCrossRefGoogle Scholar
  16. Dupas B, Cirot T, Rymer R, Barbin JG, Collin P, Sorin B, Barbin J Y (1984) Aspect échographique des loges de splénectomie non drainées. 5 th Congress of the European federation of societies for ultrasound in medicine and biology, 1984, Strasbourg, abstract p 73Google Scholar
  17. Eisenstein M, Ralls PW, Colletti P, Halls J (1983) Posttraumatic intrahepatic biloma: sonographic diagnosis. AJR 140: 303–305Google Scholar
  18. Foley WD, Cates JD, Kellman GM et al. (1987) Treatment of blunt hepatic-injuries: role of CT. Radiology 164:635–638PubMedGoogle Scholar
  19. Friday RO, Barriga P, Crummy AP (1975) Detection and localisation of intra-abdominal abscesses by diagnostic ultrasound. Arch Surg 110: 335–337PubMedGoogle Scholar
  20. Goldberg BB, Kotler MN, Ziskin MC, Waxham RD (1975) Diagnostic uses of ultrasound. Grune and Stratton, New YorkGoogle Scholar
  21. Golding RH, Li DKB, Cooperberg PL (1982) Sonographic demonstration of air-fluid levels in abdominal abscesses. J Ultrasound Med 1:151–155PubMedGoogle Scholar
  22. Gore RM, Callen PW, Filly RA (1982) Lesser sac fluid in predicting the etiology of ascites: CT findings. AJR 139: 71–74PubMedGoogle Scholar
  23. Hager J, Egender G (1985) Die Bedeutung der Sonographie als Akutdiagnostikum und zur Verlaufsbeobachtung beim stumpfen Bauchtrauma im Kindesalter. Fortschr Röntgenstr 143 (1): 44–48CrossRefGoogle Scholar
  24. Hill MC, Rieh JI, Mardiat JG, Finder CA (1985) Sonography vs. excretory urography in acute flank pain. AJR 144:1235–1238PubMedGoogle Scholar
  25. Holm HH, Kristensen JK, Rasmussen SN, Pedersen JF, Hancke S (1980) Abdominal ultrasound, 2nd edn. Munksgaard, CopenhagenGoogle Scholar
  26. Hoppens T, Coggs GC, Goldstein HM, Smith BD (1982) Sonographic diagnosis of afferent loop obstruction. AJR 138: 967–969Google Scholar
  27. Huang-Jen-I, Chou Yi-Hong, Wu Chunn-Chi, Chang Tsuen (1987) Real-time ultrasound diagnosis of acute appendicitis. 1 st congress of Asian federation of societies for ultrasound in medicine and biology (AFSUMB), 1987, TokyoGoogle Scholar
  28. Kaude JV, Mclnnis AN (1982) Pancreatic ultrasound following blunt abdominal trauma. Gastrointest Radiol 7: 53–56PubMedCrossRefGoogle Scholar
  29. King PS, Cooperberg PL, Madigan SM (1986) The ane-choic crescent in abdominal aortic aneurysms: not a sign of dissection. AJR 146: 345–348PubMedGoogle Scholar
  30. Kratochwil A, Rosenmayer F, Howawietz L (1973) Diagnosis of a traumatic pancreas cyst by means of ultrasound. Ultrasound Med Biol 1:49–52CrossRefGoogle Scholar
  31. Kristensen JK, Buemann B, Kühl E — Ultrasonic scanning in the diagnosis of splenic hematomas. Acta ChirGoogle Scholar
  32. Kuhn FP, Schreyer T, Schild H, Klose K, Günther R (1983) Sonographie beim stumpfen Bauchtrauma. Fortschr Röntgenstr 139 (3): 310–313CrossRefGoogle Scholar
  33. Laing FC, Brooke Jeffrey R Jr, Wing VW (1985) Ultrasound versus excretory urography in evaluating acute flank pain. Radiology 154:613–616PubMedGoogle Scholar
  34. Larson JM, Peira JC, Ellinger DM, Parish GH, Hammond DC et al. (1989 a) The validity and utility of sonography in the diagnosis of appendicitis in the community setting. AJR 153:687–691PubMedGoogle Scholar
  35. Larson JM, Ellinger DM, Zdybel PJ et al. (1989) Acute Meckel’s diventriculitis: diagnosis by US. J Clin Ultrasound 17: 682–684PubMedCrossRefGoogle Scholar
  36. Lee DH, Lim JH, Ko YT et al. (1990) Sonographic detection of pneumoperitoneum in patients with acute abdomen. AJR 154:107–109PubMedGoogle Scholar
  37. Lorenz R, Beyer D, Friedmann G, Eisenhardt HJ (1983) Bedeutung von Sonographie und Computertomographie für die Diagnose intraperitonealer Galleansammlungen (Galleaszites-Biliom). Fortschr Röntgenstr 138 (1): 14–18CrossRefGoogle Scholar
  38. Madrazo BL, Hricak H, Sandler MA, Eyler WR (1981) Sonographic findings in complicated peptic ulcer. Radiology 140:457–461PubMedGoogle Scholar
  39. Martin E, Dubois-Gordieff A (1983) Les pseudo-tumeurs et tumeurs bénignes du foie de l’adulte et de l’enfant. Gastroenterol Clin Biol 7: 755–760PubMedGoogle Scholar
  40. Mirvis SE, Whitley NO, Vainwright JR, Gens DR (1989 a) Blunt hepatic trauma in adult: CT based classification and correlation with prognosis and treatment. Radiology 171:27–32PubMedGoogle Scholar
  41. Mirvis SE, Whitley NO, Vainwright JR, Gens DR (1989 b) Blunt splenic trauma in adults: CT based classification and correlation with prognosis and treatment. Radiology 171: 33–39Google Scholar
  42. Meyers M, Oliphant M, Berne AS, Feldberg MA (1987) The peritoneal ligaments and mesenteric: pathways of intraabdominal spread of disease. Radiology 63: 593–605Google Scholar
  43. Ogata M (1990) Us findings in the intestinal well with hemorrhagic necrosis caused by strangulation ileus. Jpn J Med Ultrasonics 17:19–24Google Scholar
  44. Panicek DM, Paquet DJ, Clark KG, Urrutia EJ, Brinsko RE (1986) Hepatic parenchymal gas after blunt trauma. Radiology 159: 343–344PubMedGoogle Scholar
  45. Puylaert JBCM (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158: 355–360PubMedGoogle Scholar
  46. Puylaert JB, Rutgers PH, Lalisang RI et al. (1987) A prospective study of US in the diagnosis of appendicitis. N Engl J Med 317:666–669PubMedCrossRefGoogle Scholar
  47. Scatamacchia SA, Raptopoulos V, Fink MP et al. (1989) Splenic trauma in adults: impact of CT grading on management. Radiology 171: 725–729PubMedGoogle Scholar
  48. Shiga T, Kauwachi A, Matsui W, Nakayama K, Naito S, Tachikawa S, Kamiya K, Katacka T, Koike T, Ishii J (1985) Ultrasonography of spleen rupture by traumatic injury. 5 th World congress of ultrasound (WFUMB), July 1985, Sydney, abstract p 114Google Scholar
  49. Siffring PKA, Forrest TS, Frick MP (1989) Hernias of the inferior lumbar space: diagnosis with US. Radiology 170:190PubMedGoogle Scholar
  50. Siegel B, Machi J, Ramos JR et al. (1985) Ultrasonic features of pneumotosis intestinalis. J Clin Ultrasound 13: 675–678Google Scholar
  51. Simeone JF, Novelline RA, Ferrucci JT Jr, Deluca SA, McCabe CJ, Mueller PR, Hall DA, Wittenberg J, Butch RJ, Papanicolaou N, Johnson R (1985) Comparison of sonography and plain films in evaluation of the acute abdomen. AJR 144:49–52PubMedGoogle Scholar
  52. Skaane P, Skennjold A (1989) US features of ileocoecal intussusception. J Clin Ultrasound 17: 590–593PubMedCrossRefGoogle Scholar
  53. Slovis TL, Haller JO, Cohen HL et al. (1989) Complicated appendiceal inflammatory disease in children: pyelophlebitis and liver abscess. Radiology 171: 823–825PubMedGoogle Scholar
  54. Swensen T, Baardsen A (1984) Ultrasonography of patients with acute appendicitis. Norsk forening for ultralyd in diagnosis, Ålesund, 29 SeptemberGoogle Scholar
  55. Thorsen MK, Lawson TL, Aiman EJ et al. (1990) Diagnosis of ectopic pregnancy: endovaginal versus transabdominal sonography. AJR 155: 307–310PubMedGoogle Scholar
  56. Van Sonnenberg E, Wing VW, Casola G, Coons HG, Nakamoto SK, Mueller PR, Ferrucci JT Jr, Halasz N, Simeone JF (1984) Temporizing effect of percutaneous drainage of complicated abscesses in critically III patients. AJR 142: 821–826Google Scholar
  57. Van Sonnenberg E, Wittich GR, Casola G, Wing VW, Halasz N, Lee AS, Withers C (1986) Lymphoceles: imaging characteristics and percutaneous management. Radiology 161: 593–596Google Scholar
  58. Vazquez JL, Thorsen MK, Dodds WJ, Quiroz FA, Martinez ML, Lawson TL, Stewart ET, Foley WD (1985) Evaluation and treatment of intraabdominal bilomas. AJR 144:933–938PubMedGoogle Scholar
  59. Vogelzang RL, Tobin RS, Burstein S et al. (1987) Trans-catheter intracavitary fibrinolysis of infected extra-vascular hematomas. AJR 143: 378–380Google Scholar
  60. Weiler S (1985) L’échotomographie dans l’urgence abdominale. Thesis, University of Besançon, BesançonGoogle Scholar
  61. Weiler S, Rohmer P, Coche G, Weill F (1986) L’échographie dans l’urgence abdominale. J Radiol 67 (11): 765–768PubMedGoogle Scholar
  62. Weill F (1978) Ultrasonography of digestive diseases, 1 st edn, Chap 25. Mosby, St LouisGoogle Scholar
  63. Weill F (1982) Ultrasonography of digestive diseases, 2 nd edn, Chap 25. Mosby, St LouisGoogle Scholar
  64. Weill F, Le Mouel A, Bihr E, Rohmer P, Zeltner F, Sauget Y (1980 a) Le diagnostic ultrasonore des collections intrapéritonéales dans les récessus hépatorénal (ou le récessus spléno-péritonéal). Le signe du croissant de lune. J Radiol 61 (4): 251–256PubMedGoogle Scholar
  65. Weill F, Le Mouel A, Rohmer P, Zeltner F, Bihr E (1980 b) L’ultrasonographie de l’abdomen aigu. Méd Hygiène 38:2458–2471Google Scholar
  66. Weill F, Bihr E, Rohmer P, Zeltner F, Le Mouel A (1981) Ultrasonic study of hepatic and traumatic lesions. Eur J Radiol 1:245–249PubMedGoogle Scholar
  67. Weill FS, Perriguey G, Belloir A, Bagni A, Rohmer P (1983) Ultrasonic anatomical study of the lesser omental sac: a pictorial essay. Eur J Radiol 3 (2): 142–147PubMedGoogle Scholar
  68. Weill FS, Rohmer P, Belloir A, Bagni P (1983) The butterfly sign: an indicator of fluid within both the greater peritoneal cavity and the lesser omental bursa. J Ultrasound Med 2:161–164PubMedGoogle Scholar
  69. Weill F, Bihr E, Rohmer P, Zeltner F (1987) Renal sonography, 2nd edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  70. Weill F, Rohmer P, Didier D, Coche G (1988) Ultrasound of the traumatized spleen: the left butterfly sign in lesions masked by echogenic blood clots. Gastrointest Radiol 13:169–172PubMedCrossRefGoogle Scholar
  71. Wing VW, Federle MP, Morris JA Jr, Brooke Jeffrey R, Bluth R (1985) The clinical impact of CT for blunt abdominal trauma. AJR 145:1191–1194PubMedGoogle Scholar
  72. Yee J, Raghavendra B, Ambrosino M, Hori S (1988) Abdominal ultrasonography in AIDS. J Ultrasound Med (Suppl) 7:45Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • Francis S. Weill
    • 1
  1. 1.La Combe d’ArollesMontfauconFrance

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