Septic peritonitis or not, might not be able to tell on US

Abdominal ultrasound has inconsistent agreement with subsequent surgery or necropsy findings in dogs and cats with septic peritonitis

Curtis G. Rheingold, Cody Dickens, Anna Tran, Rebecka S. Hess, Yekaterina Buriko

Background
Septic peritonitis is a severe condition in small animals, often resulting in significant morbidity and mortality. While abdominal ultrasound is commonly used in clinical practice to diagnose intra-abdominal pathology, its accuracy in detecting septic peritonitis and its causative lesion remains uncertain. This study aimed to evaluate the reliability of ultrasound in diagnosing septic peritonitis and identifying the underlying lesion compared to findings at surgery or necropsy.

Methods
A retrospective case series was conducted on 84 dogs and 10 cats diagnosed with septic peritonitis at a veterinary referral hospital. All animals underwent an abdominal ultrasound before confirmation of septic peritonitis via exploratory laparotomy or necropsy. The accuracy of ultrasound findings was compared to surgical or postmortem results. The study also analyzed whether lesion location, lesion type, patient species, or body weight affected diagnostic accuracy and patient survival.

Results
The gastrointestinal tract was the most common site of lesions (70.2%), with nonneoplastic ulceration or perforation being the predominant pathology (50%). Abdominal ultrasound correctly diagnosed septic peritonitis in 56.3% of cases and identified the causative lesion in 67% of cases. Lesions of the gastrointestinal tract were most frequently detected (68% accuracy), while those in the hepatobiliary system and non-GI organs were often missed. Ultrasound was more accurate in detecting nonneoplastic ulcerations or perforations (70%) compared to other lesion types (30%). Neither patient species nor body weight significantly influenced diagnostic accuracy.

Limitations
The study was retrospective, and variability in ultrasound operator skill, technique, and equipment may have influenced results. The sample size, particularly for cats, was small. Additionally, some patients may have had concurrent sonographic lesions that could limit the specificity of ultrasound findings for septic peritonitis.

Conclusions
Abdominal ultrasound is unreliable for diagnosing septic peritonitis, as it failed to detect the condition in nearly half of the confirmed cases. While it was more effective at identifying gastrointestinal tract lesions, it was less reliable for lesions in the hepatobiliary system or other organs. Given the time-sensitive nature of septic peritonitis, reliance on ultrasound may delay necessary surgical intervention. Cytology of peritoneal effusion remains the most accurate diagnostic method, and ultrasound should be used selectively for surgical planning rather than as a mandatory step in diagnosis.

Disclaimer: The summary generated in this email was created by an AI large language model. Therefore errors may occur. Reading the article is the best way to understand the scholarly work. The figure presented here remains the property of the publisher or author and subject to the applicable copyright agreement. It is reproduced here as an educational work. If you have any questions or concerns about the work presented here, reply to this email.