Correlation of gastrointestinal perforation location and amount of free air and ascites on CT imaging

Abstract

Purpose To analyze the amount of free abdominal gas and ascites on computed tomography (CT) images relative to the location of a perforation. Methods We retrospectively included 172 consecutive patients (93:79 = m:f) with GIT perforation, who underwent abdominal surgery (ground truth for perforation location). The volume of free air and ascites were quantified on CT images by 4 radiologists and a semiautomated software. The relation of the perforation location (upper/lower GIT) and amount of free air and ascites was analyzed by the Mann–Whitney test. Furthermore, best volume cutoff for upper and lower GIT perforation, areas under the curve (AUC), and interreader volume agreement were assessed. Results There was significantly more abdominal ascites with upper GIT perforation (333 ml, range 5 to 2000 ml) than with lower GIT perforation (100 ml, range 5 to 2000 ml, p = 0.022). The highest volume of free air was found with perforations of the stomach, descending colon and sigmoid colon. Significantly less free air was found with perforations of the small bowel and ascending colon compared to the aforementioned. An ascites volume > 333 ml was associated with an upper GIT perforation demonstrating an AUC of 0.63 ± 0.04. Conclusion Using a two-step process based on the volumes of free air and free fluid can help localizing the site of perforation to the upper, middle or lower GI tract. Graphic abstract

Diagnostic error rates and associated factors for lower gastrointestinal perforation

“…Third, about half of the cases in our study were diagnosed as lower gastrointestinal perforations based on the radiologist's report of the CT images. In about 10% of cases, radiologists reportedly misjudged whether the perforation was in the upper or lower gastrointestinal tract 20 . Although this study excluded cases in which the radiologist could not determine the site of perforation, it should be noted that the radiologist's judgment is not absolute in nonoperative cases.…”

The role of immature granulocyte in the early prediction of gastrointestinal tract perforations

“…Clinical findings vary based on the perforation site. Esophageal perforations may present with severe chest pain and vomiting, gastroduodenal perforations with acute severe abdominal pain, and colonic perforations with bacterial peritonitis with a slower course and abdominal examination findings due to localized abscess formation [11]. Physical examination, laboratory findings, and radiological chest and abdominal X-rays are used for the diagnosis of a GIS perforation.…”

Đặc Điểm Hình Ảnh Thủng Dạ Dày Tá Tràng Trên X-Quang Cắt Lớp Điện Toán

“…Khí tự do ổ bụng được chúng tôi ghi nhận ở 97,1%. Dấu hiệu này được báo cáo với tỉ lệ trong khoảng 97-100% [3], [5], [7], [9], [12]. Các vị trí chuyên biệt của khí tự do ổ bụng gồm: Quanh vòm gan (79,4%), vùng rốn gan (73,5%) và cạnh dây chằng liềm (64,7%).…”

“…Lượng khí tự do cũng giúp gợi ý vị trí thủng. Theo Drakopoulos (2021), lượng khí tự do ổ bụng trong thủng DDTT nhiều hơn trong thủng ruột non và đại tràng, lượng khí tự do trong thủng dạ dày nhiều hơn trong thủng tá tràng [5].…”

“…Tỉ lệ này cũng phù hợp các tác giả. Theo Grassi (2004) và Drakopoulus (2021), tỉ lệ thủng dạ dày và tá tràng lần lượt tương ứng là 61,7% và 38,3% và 62,5% và 37,5% [6], [5]. Vị trí thủng thường gặp vẫn là vùng hang môn vị dạ dày và mặt trước hành tá tràng.…”