Segmental bowel wall thickening, abnormal bowel wall enhancement, perivisceral fat stranding and abscess formation may be detected as indirect findings of perforation. Direct signs of perforation on MDCT include focal bowel wall discontinuity, extraluminal gas, and extraluminal enteric contrast agent leakage.
#Barotrauma colon free#
Multidetector computed tomography (MDCT) is much better suited for detection of free air with a reported success rate around 85 %. Diverticular perforation can be challenging to detect sonographically. Sonographic evaluation of perforated diverticulitis performed with a high frequency linear transducer better reveals wall thickening and edema in the affected bowel segment. In the setting of perforated diverticulitis, subdiaphragmatic free air may be seen on upright abdominal X-rays. The clinical presentation may be insidious and relatively silent in these patients causing delayed diagnosis and potentially life-threatening complications. Retroperitoneal air can result from perforation of second and third portions of duodenum, posterior aspect of the ascending, descending and sigmoid colon segments. Intraperitoneal perforation may present with acute abdominal pain, nausea and vomiting. Free air is usually detected locally with well-contained perforation while widespread intraabdominal free air is detected in large non-contained perforations (Fig. Well-contained perforations manifest as small and self-limited however, non-contained perforations which occur in 1 %–2 % of patients with acute diverticulitis may lead to local abscess and fistula formation (Fig. Perforation from colonic diverticulitis almost always occurs on the left side. Perforation of diverticulitis occurs secondary to severe inflammation of bowel wall layers with subsequent necrosis and loss of intestinal wall integrity. These conditions should be promptly diagnosed and treated in order to prevent increased morbidity and mortality. However, unusual and more severe complications such as non-contained perforation, phlegmon and abscess, phylephlebitis, intestinal obstruction, bleeding, and fistula necessitate intensive management. Small sized, well-contained perforations are common in the course of the disease and most cases can be managed conservatively with antibiotics and supportive medical treatment. Severity of inflammation, involvement of bowel segment and local and distant complications of diverticulitis can be assessed with CT.Ĭomplications of diverticulitis may be highly variable, and it may be difficult to diagnose diverticulitis as an underlying cause of severe complications. Computed tomography is the mainstay imaging technique in the diagnosis of diverticulitis and its complications. Gentle compression with US transducers generally induce tenderness and pain. Adjacent bowel wall edema and thickening with edematous hyperechoic mesentery can be visualized on US. In diverticulitis, US demonstrates inflamed diverticulum as a noncompressible outpouching of a bowel wall with thickened and hypoechoic wall often containing an obstructive fecalith at the ostium. Ultrasonography (US) is generally the first imaging modality used in the evaluation of acute abdomen.
The underlying pathophysiology of diverticulitis is the obstruction of the diverticular ostium by a stool fragment or food particles and subsequent inflammation. Approximately 10 %–25 % of patients with known colonic diverticulosis will have diverticulitis in their lifetime. Acute diverticulitis constitutes 3.8 % of causes of abdominal pain in patients presented to the emergency departments. © 2016 American Academy of Forensic Sciences.Diverticulitis is one of the most frequent bowel emergencies presenting with acute abdomen. Acute heart failure played an important role in this death.Īscending colon barotrauma compressed air death forensic science rare transverse colon. The pathological framework of lung congestion made it possible to identify the mechanism responsible for this death as depletion of the heart's pumping function, which contributed significantly to the acute respiratory failure due to respiratory distress as well as to reduced mobility of the diaphragm due to intestinal distension. Here, the authors describe an autoptic case of death from lesions of the ascending and transverse segments, with perforations and bleeding suffusions as well as ischemic areas covered the colonic wall that was extremely thinned, congested, and hemorrhagic, with considerable flattening leading to disappearance of the mucosal folds and with numerous petechial hemorrhages. Moreover, their pathogenic mechanism is a topic of discussion because these lesions have multiple characteristics. Lesions of the digestive tract due to barotrauma resulting from compressed air application are not common, are rarely lethal, and largely affect the sigmoid and descending colon.
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