[Acute abdomen with intraperitoneal bowel perforation-demonstration by CT scan]

Area of Science:

• Radiology
• Gastroenterology
• Surgical Pathology

Background:

• Bowel perforation is a critical surgical emergency.
• Accurate preoperative diagnosis is vital for optimal patient outcomes.
• Computed tomography (CT) is a key imaging modality in evaluating suspected bowel perforation.

Purpose of the Study:

• To evaluate the diagnostic accuracy of abdominal CT scans in surgically confirmed cases of bowel perforation.
• To identify CT findings indicative of perforation site and differentiate between upper and lower gastrointestinal perforations.

Main Methods:

• Retrospective review of 98 surgically proven bowel perforation cases.
• Analysis of preoperative abdominal CT scans from 25 patients.
• Correlation of CT findings with surgical evidence of perforation.

Main Results:

• CT scans demonstrated free gas or fluid in 80% of cases; fluid was sometimes scanty.
• Perforation sites were identified via direct (ulceration, abscess, tumor) or indirect (hematoma, extraluminal gas, phlegmon) CT evidence.
• Massive free air with air-fluid levels suggested upper abdominal perforation; air-fluid levels were absent in lower GI perforations.
• Negative CT findings or absence of free air/fluid did not exclude perforation.

Conclusions:

• Abdominal CT is valuable in diagnosing bowel perforation, detecting free gas/fluid in most cases.
• Specific CT findings can help localize the perforation site and differentiate upper from lower GI origins.
• Careful interpretation of CT, considering both direct and indirect signs, is crucial, as negative scans do not rule out perforation.