Published online Oct 16, 2021. doi: 10.12998/wjcc.v9.i29.8858
Peer-review started: May 30, 2021
First decision: June 27, 2021
Revised: June 29, 2021
Accepted: August 16, 2021
Article in press: August 16, 2021
Published online: October 16, 2021
Processing time: 137 Days and 20.4 Hours
Gastrointestinal perforation complicated by subphrenic abscess is a surgical emergency. Its diagnosis relies mainly on X-ray or computed tomography (CT), while the value of ultrasound, especially contrast-enhanced ultrasound (CEUS), has been underestimated.
A 37-year-old man presented with fever and edema of the lower extremities for 10 d. He had a history of laparoscopic repair of gastroduodenal perforation 6 mo prior. His first-time intravenous CEUS indicated a diagnosis of subphrenic abscess. He received antibiotic therapy and ultrasound-guided percutaneous drainage of the abscess. However, second-time intravenous CEUS revealed an unsatisfactory therapeutic effect. Intracavitary CEUS was proposed, and this examination detected communication between the abscess and the stomach. Upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess was diagnosed with the help of CEUS. Abdominal CT and esophagogastroduodenoscopy confirmed the diagnosis. The patient recovered after the perforation was repaired by surgery.
Intravenous and intracavitary CEUS provides helpful information for the diagnosis of upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess.
Core Tip: Gastrointestinal perforation complicated by subphrenic abscess is a surgical emergency that is diagnosed mainly by X-ray or computed tomography. We present a case diagnosed with upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess, with the rare application of intravenous and intracavitary contrast-enhanced ultrasound (CEUS). This case highlights that CEUS provides helpful information for diagnosis, with the advantages of bedside availability, real-time application, convenience, economical aspect, and lack of radiation.