Peritoneal serbest cisim

Özet

Peritoneal serbest cisim, sıklıkla torsiyone epiploik apendiks yağ dokusunun zamanla fibrotikleşip kalsifiye olmasıyla oluşan, periton boşluğunda serbest hareket edebilen nadir bir oluşumdur. Kontrastsız BT, yuvarlak veya oval yumuşak doku dansiteli cismin merkezindeki kalsifikasyonu ve çevresindeki ince yumuşak doku halkasını gösterebilir. Önceki ya da pozisyon değiştirilerek yapılan görüntülemede yer değiştirmesi tanı için güçlü bir ipucudur. Pelvik tümör veya yabancı cisim sanılması gereksiz cerrahiye yol açabilir; sabit, invaziv ya da çevre reaksiyonu oluşturan kitleler ise farklı nedenleri düşündürür.

Faz ve pencere

Kontrastsız tanısal

Peritoneal serbest cisim için kontrastsız kesit yeterli morfolojik değerlendirmeyi sağlar: iyi sınırlı yuvarlak/oval yumuşak doku dansiteli cisim içinde merkezî, tabakalı veya düzensiz kalsifikasyon ve çevresinde ince yumuşak doku halkası görülebilir. Kontrast fazı tanı için zorunlu değildir.

BT bulguları

• Pelviste veya başka bir peritoneal reseste yuvarlak ya da oval, düzgün sınırlı solid cisim izlenir.
• Cismin merkezinde küçük kalsifik odak veya konsantrik tabakalı kalsifikasyon bulunabilir.
• Tipik olarak düzgün sınırlı yuvarlak/oval yumuşak doku dansiteli cisim içinde merkezi veya konsantrik kalsifikasyon ve çevresinde yumuşak doku halkası izlenir; hipodens merkez ya da tabakalı dış görünüm değişken olabilir.
• Komşu organlardan ince yağ planıyla ayrılması ve çevre dokuda belirgin inflamasyon oluşturmaması serbest yerleşimi destekler.
• Pozisyon değişikliği veya seri incelemede cismin farklı peritoneal konumda görülmesi mobiliteyi doğrular.
• Büyük cisimler nadiren mesane, rektum veya ince barsağa bası yapabilir; komşu lümen ve organ konturları incelenmelidir.
• Önceki cerrahi varsa yabancı cisim/gossypiboma ayırıcı tanıya girer; gaz kabarcıkları, tekstil işaretleyici veya çevresel reaksiyon lehine bulgular aranır.

Normalde

Normal peritoneal boşlukta ayrı, yuvarlak kalsifikasyonlu yumuşak doku cismi bulunmaz; mesane ve rektum çevresi yağ planları serbesttir. Kıyaslamada lezyonun merkezî kalsifikasyonunu, ince dış yumuşak doku tabakasını, çevre organlara yapışık olmamasını ve eski görüntülerdeki konumunu değerlendir.

Ayırıcı tanı

Gossypiboma

cerrahi öyküyle ilişkili sabit kitle, tekstil materyali, gaz odakları veya çevresel granülomatöz reaksiyon gösterebilir; serbestçe göç etmesi beklenmez.

Kalsifiye lenf düğümleri de peritoneal serbest cismin ayırıcı tanısında yer alır.

Dermoid/teratom, merkezî kalsifikasyonlu pelvik peritoneal serbest cisim için ayırıcı tanıda düşünülmüştür.

Uterin leiomyom pelvik kitle ayırıcı tanısında yer alır; kadınlarda bazı peritoneal serbest cisimlerin otoampute uterin leiomyomdan kaynaklanabileceği bildirilmiştir.

Düşmüş safra taşları, özellikle laparoskopik kolesistektomi sonrasında peritoneal boşlukta kalabilir ve peritoneal serbest cismi taklit edebilir.

Tuzaklar

• Tek bir BT'de mesane arkasındaki serbest cisim over veya rektosigmoid kitle gibi görünebilir; organla devamlılık olup olmadığını çok düzlemde ara.
• Önceki görüntüleme yoksa farklı pozisyonda ek tarama veya takip incelemesi cismin mobilitesini gösterebilir ve tanıya yardımcı olabilir.
• Ameliyat öyküsünde kalsifik kitleyi otomatik olarak serbest cisim sayma; gossypiboma genellikle sabit kalır ve çevresel reaksiyon veya karakteristik tekstil işaretleri gösterebilir.
• Merkezî kalsifikasyon boyutu ve düzeni değişkenlik gösterir; kesit incelemelerinde hipodens merkezli yapılar dikkatle izlenmelidir.

Kendini dene

1. Kontrastsız BT'de kalsifikasyon içeren iyi sınırlı bir kitle görülüyor. Önceki BT'de aynı kitlenin yeri farklı. Bu bulgu neyi gösterir?

   • Kitlenin hareketli olduğunu
   • Kitlenin mesane duvarından kaynaklandığını
   • Kitlenin komşu organa yapışık olduğunu
   • Kitlenin damarlanmasının arttığını
   Cevabı göster

   Kitlenin hareketli olduğunu. Seri görüntülerde kitlenin yer değiştirmesi, periton içi serbest cismin hareketli olduğunu gösterir ve tanıya yardımcı olabilir.

2. Önceki cerrahi öyküsü olan bir hastada BT'de çevre yapılara veya cerrahi skara yapışık, düzensiz kenarlı bir kitle görülüyor. Hangi ayırıcı tanı bu bulgularla uyumludur?

   • Unutulmuş cerrahi materyal (gossypiboma)
   • Peritoneal serbest cisim
   • Uterin leiomyom
   • Gastrointestinal stromal tümör
   Cevabı göster

   Unutulmuş cerrahi materyal (gossypiboma). Gossypiboma BT'de düzensiz kenarlı olabilir ve çevre yapılara veya önceki cerrahi skarlara yapışıklık gösterebilir.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.