Peritonitis and End Ileostomy

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Peritonitis and End Ileostomy

• By Borko Kereshi, MSIII

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The case

• 48 year old female with end-stage renal disease
  and history of pancreatitis.
• Status post colectomy for ischemic colitis.
• End Ileostomy placed

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What do you see?
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Findings
End ileostomy
Parastomial hernia with free fluid around
ileostomy
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Parastomial hernia with free fluid around
ileostomy
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What do you see?
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Findings
Thickened and enhancing peritoneum, consistent
with peritonitis.
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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

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Fat stranding around the pancreatic tail. This
could be part of peritonitis. Alternatively this
may be secondary to focal pancreatic tail
inflammation
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Abnormal fluid collection anterior to liver
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Coronal View
Fluid!
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More fluid!
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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.