Peritonitis and End Ileostomy

By Borko Kereshi, MSIII

The case

• 48 year old female with end-stage renal disease and history of pancreatitis.

• Status post colectomy for ischemic colitis.

• End Ileostomy placed

What do you see?

FindingsEnd ileostomy

Parastomial hernia with free fluid around ileostomy

Parastomial hernia with free fluid around ileostomy

What do you see?

Findings

Thickened and enhancing peritoneum, consistent with peritonitis.

Peritonitis, cause and result

• Diffuse peritonitis occurs when the cause of the peritoneal inflammation is not contained or there is overwhelming infection. Generalized peritonitis can result from infective or chemically irritative causes.

• On CT, there is smooth peritoneal contrast enhancement

Fat stranding around the pancreatic tail. This could be part of peritonitis. Alternatively this may be secondary to focal pancreatic tail inflammation

Abnormal fluid collection anterior to liver

Coronal View

Fluid!

More fluid!

References

• K Gordon, WK Lee, O Hennessy. Computed tomography manifestations of peritoneal diseases. Australasian Radiology. VL: 49. NO: 4. 2005. Department of Medical Imaging, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.