Role of Multidetector Computed Tomography in the Diagnosis of Colorectal Perforations

Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology

“…Colorectal perforation carries the highest complication rate (55%) compared with other GIT perforation sites [47]. This is unsurprising considering the bacterial content of the large bowel that evokes bacterial peritonitis [1,4]. Perforations contained in retroperitoneal spaces usually present with subtle symptomatology [6,27].…”

“…Perforation may also be iatrogenic (20%), diverticula-related (19%) and less commonly due to trauma, foreign body ingestion, faecal impaction, ischemia, inflammatory bowel disease, endometriosis, connective tissue disease, radiotherapy, drugs and spontaneous [4,6,7,10,11,49]. The site of perforation is often linked with its cause [4,8,10]; therefore, neoplastic, spontaneous, diverticular (in western countries), blunt trauma and ischemic perforations commonly occur on the left side of colon, whereas inflammatory bowel disease, diverticulitis (in eastern countries) and penetrating trauma perforations tend to be right-sided. The rectosigmoid is most commonly affected in iatrogenic manipulations and foreign bodies [4,6].…”

“…The site of perforation is often linked with its cause [4,8,10]; therefore, neoplastic, spontaneous, diverticular (in western countries), blunt trauma and ischemic perforations commonly occur on the left side of colon, whereas inflammatory bowel disease, diverticulitis (in eastern countries) and penetrating trauma perforations tend to be right-sided. The rectosigmoid is most commonly affected in iatrogenic manipulations and foreign bodies [4,6]. The cecum may perforate when it reaches 12-14 cm in diameter as a result of a rapid increase in intraluminal pressure in bowel obstruction with a competent ileocaecal valve, toxic megacolon, stercoral colitis and acute colonic pseudo-obstruction [4,8,11].…”

“…The rectosigmoid is most commonly affected in iatrogenic manipulations and foreign bodies [4,6]. The cecum may perforate when it reaches 12-14 cm in diameter as a result of a rapid increase in intraluminal pressure in bowel obstruction with a competent ileocaecal valve, toxic megacolon, stercoral colitis and acute colonic pseudo-obstruction [4,8,11]. Extraluminal gas limited in the pelvis or within retroperitoneal compartments suggests colorectal perforation with the exception of right-sided retropneumoperitoneum which may also result from duodenal perforation.…”

“…Despite progress in emergency medicine, gastrointestinal tract perforation remains a condition associated with considerable mortality, ranging from 30 to 50% [1,2]. Clinical presentation varies: oesophageal perforations can present with non-specific symptoms such as acute chest pain, odynophagia and vomiting [2], gastroduodenal perforations typically present with acute abdominal pain [1,3], whereas colonic perforations tend to follow a slower progression course, presenting with secondary bacterial peritonitis or localised abscess formation [1,4]. A subset of patients exhibits delayed symptoms, abscess formation that mimics an abdominal mass, or with sepsis [3].…”