Physiologic pelvic intraperitoneal fluid

doi:10.1017/CBO9781139135047.070

Case 69 - Physiologic pelvic intraperitoneal fluid

from Section 6 - Pelvis

Published online by Cambridge University Press: 05 March 2013

Martin L. Gunn

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Martin L. Gunn

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Martin L. Gunn: Affiliation:
University of Washington School of Medicine

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Summary

Imaging description

Given the frequency that CT of the abdomen and pelvis is performed to evaluate the trauma patient, intraperitoneal “free” fluid is encountered quite often. Although a small quantity of isolated free intraperitoneal fluid is usually attributed to physiologic fluid in women of reproductive age, it is also seen in males.

Whilst in the past it was believed that free fluid identified on CT was an indicator of occult bowel, mesenteric, or solid organ injury, and it mandated laparotomy [1], it is now generally accepted that conservative management with a non-operative approach for hemodynamically stable patients who have a small quantity of free pelvic fluid is safe (Figure 69.1). These patients should have no clinical or imaging signs of bowel injury [2, 3]. The change in approach to small quantities of free pelvic fluid is likely related to the evolution of CT itself. Decreasing reconstruction slice thickness, and the introduction of routine multiplanar reformations likely increases the sensitivity of CT for the detection of small quantities of free intraperitoneal fluid [4].

Type: Chapter
Information: Pearls and Pitfalls in Emergency Radiology
Variants and Other Difficult Diagnoses
, pp. 230 - 231

DOI: https://doi.org/10.1017/CBO9781139135047.070 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2013

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References

Cunningham, MA, Tyroch, AH, Kaups, KL, Davis, JW.Does free fluid on abdominal computed tomographic scan after blunt trauma require laparotomy?J Trauma. 1998;44(4):599–602; discussion 603.CrossRef Google Scholar PubMed

Brofman, N, Atri, M, Hanson, JM, et al. Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics. 2006;26(4):1119–31.CrossRef Google Scholar PubMed

Rodriguez, C, Barone, JE, Wilbanks, TO, Rha, CK, Miller, K.Isolated free fluid on computed tomographic scan in blunt abdominal trauma: a systematic review of incidence and management. J Trauma. 2002;53(1):79–85.CrossRef Google Scholar PubMed

Yu, J, Fulcher, AS, Wang, DB, et al. Frequency and importance of small amount of isolated pelvic free fluid detected with multidetector CT in male patients with blunt trauma. Radiology. 2010;256(3):799–805.CrossRef Google Scholar PubMed

Drasin, TE, Anderson, SW, Asandra, A, Rhea, JT, Soto, JA.MDCT evaluation of blunt abdominal trauma: clinical significance of free intraperitoneal fluid in males with absence of identifiable injury. AJR Am J Roentgenol. 2008;191(6):1821–6.CrossRef Google Scholar PubMed

LeBedis, CA, Anderson, SW, Soto, JA.CT imaging of blunt traumatic bowel and mesenteric injuries. Radiol Clin North Am. 2012;50(1):123–36.CrossRef Google Scholar PubMed

Atri, M, Hanson, JM, Grinblat, L, et al. Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology. 2008;249(2):524–33.CrossRef Google Scholar PubMed

Lawson, CM, Daley, BJ, Ormsby, CB, Enderson, B.Missed injuries in the era of the trauma scan. J Trauma. 2011;70(2):452–6; discussion 456–8.CrossRef Google Scholar PubMed

Killeen, KL, Shanmuganathan, K, Poletti, PA, Cooper, C, Mirvis, SE.Helical computed tomography of bowel and mesenteric injuries. J Trauma. 2001;51(1):26–36.CrossRef Google Scholar PubMed