19/03/2025
A must watch video for those who are looking for advanced approach to solve specific abdominal pathologies;
Case: scan displaying multiple pools of fluid in peritoneal cavity, fluid containing debris like echoes and mesh work of thin membranes or separations.
Guts are moderately dilated,
Patient is fibrile ,
Complaining of vague abdominal Pain .
Watch how to approach and brain storm :
Based on the ultrasound findings and clinical presentation, the probable diagnosis could be fibrinous peritonitis, likely due to an intra-abdominal infection such as secondary bacterial peritonitis. Here’s the reasoning:
1. Free fluid in the peritoneal cavity with thin membranes and debris
This suggests an exudative process rather than a simple transudative ascites. The presence of fibrinous strands and debris indicates an inflammatory or infectious process.
2. Fluid in the hepatorenal angle (Morison’s pouch)
This is often an early site for fluid accumulation in intra-abdominal infections, trauma, or peritonitis.
3. Mild to moderate gut distension
This could be due to ileus, which commonly accompanies peritoneal inflammation or infection.
4. Febrile patient
Fever strongly suggests an infectious etiology, possibly related to perforation, post-surgical infection, abscess rupture, or spontaneous bacterial peritonitis (SBP) in a cirrhotic patient.
Differential Diagnoses:
Peritonitis (bacterial, tuberculous, or secondary to perforation)
Perforated viscus (e.g., perforated appendix, perforated peptic ulcer, or diverticular perforation)
Postoperative or post-traumatic peritoneal infection
Intra-abdominal abscess rupture
Next Steps:
Clinical correlation: Check for peritoneal signs (rebound tenderness, guarding).
Lab tests: CBC (leukocytosis?), CRP, blood cultures, and peritoneal fluid analysis (if possible).
Further imaging: Contrast-enhanced CT abdomen to identify the source (e.g., bowel perforation, abscess).
Now watch my endeavors please.......(DUC 19.3.2025
