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Large Gastric Perforation Sealed by Splenic Lysis: Emphasis on Indirect Signs - A Rare Case Report.

Garg L, Jain M, Taori K, Patil A, Hatgaonkar A, Rathod J, Shah S, Patwa D, Kasat A - Pol J Radiol (2015)

Bottom Line: The delay before surgical treatment is a strong determinant of poor outcome, associated complications and hospitalization costs.MDCT of the abdomen was done which revealed atrophic pancreas with organized collection in the sub-capsular location indenting the superior pole of the left kidney.It acted as the 2(nd) policeman and provided a great clue to solve the diagnostic dilemma.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnois, Government Medical College, Nagpur, India.

ABSTRACT

Background: Gastric perforation is a life-threatening condition, requiring early and reliable discovery. The delay before surgical treatment is a strong determinant of poor outcome, associated complications and hospitalization costs. By using ultrasound and multi-detector computed tomography (MDCT) we can further evaluate undiagnosed cases of silent gastric perforations presenting with non-specific acute abdomen. Here we bring forth the role of a radiologist in cases of perforation which present with indirect signs involving the organs forming the stomach bed, like the spleen, pancreas and kidney.

Case report: A 25-year-old male patient presented with an acute onset of severe upper abdominal pain radiating to the back and vomiting. MDCT of the abdomen was done which revealed atrophic pancreas with organized collection in the sub-capsular location indenting the superior pole of the left kidney. Spleen was not visualized. The most striking imaging finding in that case was destruction of the splenic parenchyma with protrusion of the remaining tissue into the stomach lumen. The hypothesis behind this was a cascade of events which started with gastric perforation, spillage of highly destructive gastric juice over the stomach bed and finally becoming silent with rapid sealing of the defect by the omentum and the spleen.

Conclusions: Acute abdomen is a diagnostic challenge to a clinician and radiologist with gastric perforation being a great mimicker of other urgent abdominal pathologies. To avoid a delayed diagnosis or a misdiagnosis, familiarity with typical and atypical imaging features is essential as in our case of splenic lysis. It acted as the 2(nd) policeman and provided a great clue to solve the diagnostic dilemma.

No MeSH data available.


Related in: MedlinePlus

CT of the abdomen; axial section showing a soft-tissue density lesion protruding within the lumen of the stomach, showing moderate enhancement and surrounded by non-enhancing collection with a rim of air foci.
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f5-poljradiol-80-499: CT of the abdomen; axial section showing a soft-tissue density lesion protruding within the lumen of the stomach, showing moderate enhancement and surrounded by non-enhancing collection with a rim of air foci.

Mentions: Abdominal MDCT was carried out and revealed atrophic pancreas with calcifications in tail region Figure 2), well-defined organized collection in the sub-capsular location indenting the superior pole of the left kidney (Figure 3) with extensive fat stranding in the perinephric space and peripancreatic region. The spleen was not visualized in the splenic fossa. However, the splenic artery was noted arising from the celiac trunk coursing along the tail of the pancreas up to a soft tissue density structure in relation to the posterior wall of the stomach measuring approximately 3.3×3×4 cm (Figure 4). The splenic vein was visualized only near the portal vein formation. The soft tissue density lesion showed moderate enhancement surrounded by non-enhancing collection and a rim of air foci. It was protruding within the lumen of the stomach (Figures 5, 6). The surrounding stomach wall appeared thickened and oedematous with perigastric fat stranding. A soft-tissue structure protruding within the stomach lumen was the spleen as the splenic artery could be traced up to it with the tail of the pancreas in relation to it. The most striking imaging finding in this case which later led us to the final diagnosis was destruction of the splenic parenchyma with protrusion of the remaining tissue into the stomach lumen.


Large Gastric Perforation Sealed by Splenic Lysis: Emphasis on Indirect Signs - A Rare Case Report.

Garg L, Jain M, Taori K, Patil A, Hatgaonkar A, Rathod J, Shah S, Patwa D, Kasat A - Pol J Radiol (2015)

CT of the abdomen; axial section showing a soft-tissue density lesion protruding within the lumen of the stomach, showing moderate enhancement and surrounded by non-enhancing collection with a rim of air foci.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4644016&req=5

f5-poljradiol-80-499: CT of the abdomen; axial section showing a soft-tissue density lesion protruding within the lumen of the stomach, showing moderate enhancement and surrounded by non-enhancing collection with a rim of air foci.
Mentions: Abdominal MDCT was carried out and revealed atrophic pancreas with calcifications in tail region Figure 2), well-defined organized collection in the sub-capsular location indenting the superior pole of the left kidney (Figure 3) with extensive fat stranding in the perinephric space and peripancreatic region. The spleen was not visualized in the splenic fossa. However, the splenic artery was noted arising from the celiac trunk coursing along the tail of the pancreas up to a soft tissue density structure in relation to the posterior wall of the stomach measuring approximately 3.3×3×4 cm (Figure 4). The splenic vein was visualized only near the portal vein formation. The soft tissue density lesion showed moderate enhancement surrounded by non-enhancing collection and a rim of air foci. It was protruding within the lumen of the stomach (Figures 5, 6). The surrounding stomach wall appeared thickened and oedematous with perigastric fat stranding. A soft-tissue structure protruding within the stomach lumen was the spleen as the splenic artery could be traced up to it with the tail of the pancreas in relation to it. The most striking imaging finding in this case which later led us to the final diagnosis was destruction of the splenic parenchyma with protrusion of the remaining tissue into the stomach lumen.

Bottom Line: The delay before surgical treatment is a strong determinant of poor outcome, associated complications and hospitalization costs.MDCT of the abdomen was done which revealed atrophic pancreas with organized collection in the sub-capsular location indenting the superior pole of the left kidney.It acted as the 2(nd) policeman and provided a great clue to solve the diagnostic dilemma.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnois, Government Medical College, Nagpur, India.

ABSTRACT

Background: Gastric perforation is a life-threatening condition, requiring early and reliable discovery. The delay before surgical treatment is a strong determinant of poor outcome, associated complications and hospitalization costs. By using ultrasound and multi-detector computed tomography (MDCT) we can further evaluate undiagnosed cases of silent gastric perforations presenting with non-specific acute abdomen. Here we bring forth the role of a radiologist in cases of perforation which present with indirect signs involving the organs forming the stomach bed, like the spleen, pancreas and kidney.

Case report: A 25-year-old male patient presented with an acute onset of severe upper abdominal pain radiating to the back and vomiting. MDCT of the abdomen was done which revealed atrophic pancreas with organized collection in the sub-capsular location indenting the superior pole of the left kidney. Spleen was not visualized. The most striking imaging finding in that case was destruction of the splenic parenchyma with protrusion of the remaining tissue into the stomach lumen. The hypothesis behind this was a cascade of events which started with gastric perforation, spillage of highly destructive gastric juice over the stomach bed and finally becoming silent with rapid sealing of the defect by the omentum and the spleen.

Conclusions: Acute abdomen is a diagnostic challenge to a clinician and radiologist with gastric perforation being a great mimicker of other urgent abdominal pathologies. To avoid a delayed diagnosis or a misdiagnosis, familiarity with typical and atypical imaging features is essential as in our case of splenic lysis. It acted as the 2(nd) policeman and provided a great clue to solve the diagnostic dilemma.

No MeSH data available.


Related in: MedlinePlus