Distension Perforation

Abdominal radiographs may be useful because free air in the abdomen (indicating intestinal perforation) or distension of the small or large bowel is often evident Ultrasound, CT scan, or magnetic resonance imaging may be used to locate an abscess. 

Peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distension, ulcerative esophagitis... 

Sodium and fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension Muscle weakness, steroid myopathy, loss of muscle mass, vertebral compression fractures, aseptic necrosis of humeral and femoral heads, pathologic fracture of long bones, osteoporosis Peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distension, ulcerative esophagitis... 

A 29-year-old woman with polycystic ovary syndrome had her first in vitro fertilization cycle of leuprorelin acetate, FSH, and human chorionic gonadotropin (hCG) (67). Within 2 days she complained of abdominal distension, shortness of breath, and abdominal pain. Over the next few days she developed massive ovarian enlargement, ascites, hyponatremia, respiratory failure, and renal insufficiency. This was further complicated by duodenal perforation, probably due to severe physical stress. 

C. Hydrogen peroxide ingestion may cause gastric distension and, rarely, perforation. Severe corrosive injury and air emboli have been rejxrrted with the concentrated forms and may be caused by the entry of gas through damaged gastric mucosa or oxygen gas liberation within the venous or arterial circulation. 

Plain film shows numerous dilated loops of bowel occupying the entire abdominal cavity, including the pelvic portion, and multiple air-fluid levels in upright film (Fig. 1.19). With this degree of distension the mucosal pattern of the small bowel is effaced and it is impossible to differentiate the small bowel from the colon (Winters et al. 1992). Examination of the colon is then warranted to disclose the presence or absence of a colonic lesion. In ileal atresia, the colon is normally placed but has an abnormally small caliber, the so-called functional microcolon typical of distal small bowel obstruction (Dalla Vecchia et al. 1998) (Fig. 1.19d,e). The presence of pneumoperitoneum indicates that perforation has occurred and a colon examination is contraindicated. Intraperitoneal calcifications, indicative of meconium peritonitis, are not uncommon in ileal atresia. 

Fig. 1.26. Meconium peritonitis with intrauterine bowel perforation. Free air within the peritoneal cavity is observed (arrows) in this neonate with ileal atresia. No bowel distension is observed. A patent bowel perforation was found at surgery...

The patient with acute intermittent porphyria suffers a severe acute abdominal pain not definitely localized and without rigidity or tenderness of the abdominal wall. Moderate fever and leukocytosis develop. If the physician is not aware of the porphyria, he is likely to be confused and suspect appendicitis, renal or biliary colics, pancreatitis, perforated ulcer, acute bowel obstruction or another common cause of abdominal pain. The differential diagnosis of porphyria and bowel obstruction is further complicated because the attacks of porphyria hepatica are often associated with severe constipation. Abdominal X-rays of porphyric patients show colonic distension. The pathogenesis of the abdominal symptoms is not known. They could result either from a direct effect of porphobilinogen or porphyrin on the intestinal mucosa or be the consequence of an increased excitability of the autonomic system. 

Presently, CT colonography has no role in the diagnosis of acute diverticulitis, and, in addition, the distension of the colon may lead to perforation. In selected cases, CTC may help in the differential diagnosis between diverticulitis and cancer after the acute inflammatory episode has subsided. 

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