Perforation and obstruction of the gastrointestinal tract. Assessment by conventional radiology

Proliferation of new imaging modalities has changed the way abdominal emergencies are evaluated in medical centers where ready access to equipment and personnel make emergency CT, ultrasonography, interventional radiology, and endoscopy available at all hours of the day or night. In many cases, plain abdominal radiography is being relegated to an ancillary diagnostic role. Conversely, in medical centers with fewer resources, plain radiography remains a primary screening modality for most acute abdominal conditions. Even in centers with unlimited resources, plain films supplemented by gastrointestinal contrast studies as needed remain the modern standard for evaluation of patients who have suspected gastrointestinal perforation and mechanical obstruction. These widely available, easy to perform, and relatively inexpensive procedures are relatively sensitive and specific for evaluation of these problems. It is, therefore, crucial for radiologists to be familiar with the often subtle signs of gastrointestinal perforation and obstruction on plain films. Skills of plain film interpretation should not be permitted to erode in the environment of newer technologies.