Presentation
2 year old male neutered domestic longhaired cat with vomiting and lethargy.
Patient Data
The stomach is markedly distended with granular material, fluid, and gas. The small intestine is normal in diameter. There are several irregular gas bubbles in the peritoneal space that are not clearly contained within bowel loops. There is free gas between the stomach, liver, and diaphragm on the lateral projections, mainly visible on the right lateral. No abnormalities are noted in the urinary tract. The spleen is mildly enlarged.The portion of the thorax included is normal.
Impression:
Free peritoneal gas likely indicates septic peritonitis.
Case Discussion
A duodenal ulcer with free gas and a small amount of peritoneal effusion were identified on abdominal ultrasound. Further diagnostics were not pursued.
Free gas is often an unusual shape compared to the gas contained in the gastrointestinal tract. It tends to collect near the diaphragm and in the center and edges of the peritoneal space. Free gas is more apparent on some projections, and this example reinforces the value of having three projections to evaluate.
The gas in the peritoneal increases the conspicuity of the serosal surfaces of organs. For example the cranial margin of the liver and the division between lobes are not normally visible. In contrast, the peritoneal fluid that is also usually present decreases the peritoneal detail. There can be a mix of both increased and decreased visibility of serosal surfaces. In this case, the amount of effusion was small and did not affect visibility.
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