Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause

Abstract

Gastrointestinal tract perforation is an emergent condition that requires prompt surgery. Diagnosis largely depends on imaging examinations, and correct diagnosis of the presence, level, and cause of perforation is essential for appropriate management and surgical planning. Plain radiography remains the first imaging study and may be followed by intraluminal contrast examination; however, the high clinical efficacy of computed tomographic examination in this field has been well recognized. The advent of spiral and multidetector-row computed tomographic scanners has enabled examination of the entire abdomen in a single breath-hold by using thin-slice sections that allow precise assessment of pathology in the alimentary tract. Extraluminal air that is too small to be detected by conventional radiography can be demonstrated by computed tomography. Indirect findings of bowel perforation such as phlegmon, abscess, peritoneal fluid, or an extraluminal foreign body can also be demonstrated. Gastrointestinal mural pathology and associated adjacent inflammation are precisely assessed with thin-section images and multiplanar reformations that aid in the assessment of the site and cause of perforation.

The comparative study of small intestinal perforation secondary to foreign body and other non-traumatic causes

“…Oral problems, wearing denture, improper mastication and poor vision are predisposing factors of foreign body ingestion. [12] The majority of our patients were the elderly, and 35% of the patients in the foreign body group were over 65 years of age. Wearing dentures was the most common predisposing factor since the presence of dentures impaired the tactile sensitivity of the palate, resulting in unconscious ingesting of foreign bodies.…”

The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

“…[1,8,14,15] Araş-tırmamızda BT bulgularından yola çıkarak gastroduodenal perforasyonu olan hastaların %85,7'sinde, ince bağırsak perforasyonu olan hastaların %85,7'sinde, kalın bağırsak perforasyonu olan hastaların %69,2'sinde, rektum perforasyonu olan hastaların %100'ünde, apendiks perforasyonu olan hastaların %90,9'unda ve tüm hastalar birlikte değerlendirildiğinde hastaların %82,9'unda perforasyon yeri doğru tespit edilmiştir.…”

“…[14] Serbest hava ya da hava-sıvı seviyesi orta hattı geçip falsiform ligamenti belirgin hale getirebilir (falsiform ligament işareti). Serbest hava lasser sac da bulunuyorsa perforasyon yeri muhtemelen duodenum ya da midenin posteriyor duvarındadır.…”

A Rare Case of Jejunal Diverticular Perforation

“…[6,7] Barium scan of the small intestine is one of the best radiological contrast study to visualize diverticula. It is contraindicated in case of perforation or acute diverticulitis to suggest a perforation.…”