Accuracy of ultrasonography in the diagnosis of peritonitis compared with the clinical impression of the surgeon

Hypothesis: Peritonitis is a well-known indication for surgery, but its pre operative cause usually is not established. We hypothesize that abdominal u ltrasonography is superior to the clinical impression of the surgeon in det ecting the cause of peritonitis. Design: A prospective case series. Setting: A major university hospital in Taiwan, Republic of China. Patients and Methods: One hundred two patients with a diagnosis of peritoni tis admitted to the Department of Emergency Medicine, National Taiwan Unive rsity Hospital, Taipei, were included in this study. All 102 patients under went an abdominal ultrasonographic examination; and the ultrasonographic fi ndings of these patients were classified into 2 categories: positive findin gs and normal screening results. The accuracy of clinical impression in det ecting the cause of peritonitis was compared with the accuracy of abdominal ultrasonography. Results: Ultrasonography and clinical impression accurately diagnosed the p eritonitis in 85 (83.3%)and 52 (51.0%) of the patients, respectively. The d ifference between ultrasonography and clinical impression in the diagnosis of peritonitis was significant (P < .001); Among 45 patients without a preo perative clinical diagnosis, a diagnosis was made by ultrasonography for 32 (71%) of them. There were a total of 98 patients with positive ultrasonogr aphic findings, and 4 patients had normal screening results. Of the 98 pati ents with positive ultrasonographic findings undergoing surgery, all had ab dominal pathological characteristics. The 4 patients with normal screening results received nonoperative treatment. Conclusions: Ultrasonography is a more sensitive technique than clinical ju dgment in diagnosing peritonitis. Ultrasonography may be a useful diagnosin g modality in patients with peritonitis in whom the clinical cause is uncle ar.