1. Peritonitis and End Ileostomy By Borko Kereshi, MSIII

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

3. What do you see?

4. Findings End ileostomy Parastomial hernia with free fluid around ileostomy

6. What do you see?

7. Findings Thickened and enhancing peritoneum, consistent with peritonitis.

8. 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

9. Fat stranding around the pancreatic tail. This could be part of peritonitis. Alternatively this may be secondary to focal pancreatic tail inflammation

10. Abnormal fluid collection anterior to liver

11. Coronal View Fluid!

12. More fluid!

13. 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.