MDCT Findings in Gastrointestinal Perforations and the Predictive Value according to the Site of Perforation

Romano, Stefania; Somma, Carmela; Sciuto, Antonio; Jutidamrongphan, Warissara; Pacella, Daniela; Esposito, Francesco; Puglia, Marta; Mauriello, Claudio; Khanungwanitkul, Khanin; Pirozzi, Felice

doi:10.3390/tomography8020056

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…Common CT findings of duodenal FB perforation include localized mesenteric fatty infiltration, focal thickening of the bowel wall and pelvic effusion 24 . Free pneumoperitoneum is rare, as the FB is gradually impacted and the perforation is locally covered with fibrin or omentum 24–26 . In addition, endoscopy can be used as a diagnostic tool, as well as for treatment.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study

Ma,

Liu,

Wang

et al. 2023

UEG Journal

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Background and AimsDuodenal perforation caused by foreign bodies (FBs) is very rare but is an urgent emergency that traditionally requires surgical intervention. Several case reports have reported the successful endoscopic removal of duodenal perforating FBs. Here we aimed to evaluate the safety and efficacy of endoscopic management of duodenal perforating FBs in adults.MethodsBetween October 2004 and October 2022, 12,851 patients with endoscopically diagnosed gastrointestinal FBs from four tertiary hospitals in China were retrospectively reviewed. Patients were enrolled if they were endoscopically and/or radiographically diagnosed with duodenal perforating FBs.ResultsThe incidence of duodenal total FBs and perforating FBs was 1.9% and 0.3%, respectively. Thirty‐four patients were enrolled. Endoscopic removal was achieved in 25 patients (73.5%), and nine patients (26.5%) received surgery. For the endoscopic group, most perforating FBs were located in the duodenal bulb (36.0%) and descending part (28.0%). The adverse events included 3 mucosal injuries and 1 localized peritonitis. All patients were cured after conventional treatment. In the surgical group, most FBs were lodged in the descending part (55.6%). One patient developed localized peritonitis and one patient died of multiple organ failure. The significant features of FBs requiring surgery included FB over 10 cm, both sides perforation, multiple perforating FBs and massive pus overflow.ConclusionEndoscopic removal of duodenal perforating FBs is safe and effective, and can be the first choice of treatment for experienced endoscopists. Surgical intervention may be required for patients with FBs over 10 cm, both sides perforation, multiple perforating FBs, or severe infections.

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Section: Discussionmentioning

confidence: 99%

“… 24 Free pneumoperitoneum is rare, as the FB is gradually impacted and the perforation is locally covered with fibrin or omentum. 24 , 25 , 26 In addition, endoscopy can be used as a diagnostic tool, as well as for treatment.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study

Ma,

Liu,

Wang

et al. 2023

UEG Journal

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“…Patient data were obtained through an electronic medical record. Patients with clinical suspicion of perforating acute abdomen after performing a computed tomography of the abdomen who underwent a surgical procedure were evaluated [ 11 , 12 ]. After, only patients with intraoperative findings of gastroduodenal perforation in the surgical report were included.…”

Section: Methodsmentioning

confidence: 99%

Gastroduodenal Perforation in Cancer Patients: Association with Chemotherapy and Prognosis

et al. 2023

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Background: Gastroduodenal perforation stands out as one of the complications in cancer patients. Despite its high mortality, its characteristics are still poorly described. This study aimed to evaluate the characteristics and outcomes of cancer patients who had gastroduodenal perforation, and the influence of chemotherapy (CMT) in these cases. Method: A retrospective analysis of patients who underwent emergency surgery with an intraoperative finding of gastroduodenal perforation. Patients who performed CMT within 60 days before perforation were considered as the CMT group. Results: Among 45 patients included, 16 (35.5%) were classified as the CMT group and the remaining 29 (64.5%) patients as the non-CMT group. There was no difference between the groups regarding sex, age, BMI, comorbidity, and laboratory exams. ECOG 2-3 was significantly more frequent in the CMT group (68.8% vs. 34.5% p = 0.027). Major postoperative complications were similar between both groups (75% vs. 58.6%, p = 0.272). The sepsis of abdominal focus was the main postoperative complication. The 30-day mortality was 55.6%, with no difference between non-CMT and CMT groups (62.5% vs. 51.7%, respectively; p = 0.486). A multivariate analysis of risk factors showed that only an age of ≥65 years was related to 30-day mortality. Conclusions: Patients with gastroduodenal perforation and oncologic treatment present high mortality, regardless of receiving recent CMT.

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“…Gastrointestinal perforation (GIP) is a surgical emergency. It can occur due to peptic ulcer, blunt or penetrating trauma, inflammatory bowel disease, iatrogenic factors, neoplasm, or foreign bodies 1 . Currently, laparoscopic methods are used instead of conventional laparotomy in appropriate cases depending on the site and cause of perforation [2][3] .…”

Section: Introductionmentioning

confidence: 99%

Gastroi̇ntesti̇nal Perforasyon Tanisinda Kullanilan Görüntüleme Yöntemleri̇ Ve Görüntüleme Bulgulari

Ilgar

Şahin

2022

JoCASS

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Purpose: To evaluate the imaging methods used in patients diagnosed with gastrointestinal perforation (GIP) and the contribution of these methods to the diagnosis. Methods: Preoperative radiological examinations of 73 patients 18 years old or older whose surgical results indicated GIP were retrospectively evaluated. The perforation sites were divided into 4 groups, namely the first segment of the gastroduodenum, part of the small intestine beginning with the second segment of the duodenum, the colorectum, and the appendix. Esophageal perforations were considered as a separate group and excluded from the study. Findings: Fifty-two (71.2%) of the patients were male. The mean age of the patients was 45.1±18.2 years with a range of 18-87 years. Forty (54.8%) patients had perforations of the appendix and 25 (34.2%) patients had perforations of the gastroduodenum. Computed tomography (CT) was performed in 56 (76.7%) of the patients, ultrasonography (USG) in 55 (75.3%), and radiography (RG) in 48 (65.8%). The evaluation of RG images of the patients for the presence of subdiaphragmatic free air showed that 50% of the patients with non-appendix perforations had subdiaphragmatic free air. The most common findings in the USG results of the patients with appendix perforations were an increase in the diameter and heterogeneity of mesenteric fatty tissue, while the most common USG finding in the patients with the other perforations was free fluid. The site of perforation was accurately determined in 83.9% of the patients diagnosed with non-appendix perforations by CT. Conclusion: CT is the most preferred imaging modality and has the most diagnostic value in the diagnosis of GIP. It is also useful in determining the perforation site.

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MDCT Findings in Gastrointestinal Perforations and the Predictive Value according to the Site of Perforation

Cited by 4 publications

References 26 publications

Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study

Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study

Gastroduodenal Perforation in Cancer Patients: Association with Chemotherapy and Prognosis

Gastroi̇ntesti̇nal Perforasyon Tanisinda Kullanilan Görüntüleme Yöntemleri̇ Ve Görüntüleme Bulgulari

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