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Published on: July 21, 2023
[Gastroduodenal perforation: the role of MDCT]
J Cazejust1, B Castaglioli, B Bessoud
1Service de Radiologie, Hôpital du Kremlin Bicêtre, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. julien.cazejust@free.fr
Objective:
To determine whether multidetector computed tomography (MDCT) is helpful for early detection of gastroduodenal perforation.
Material And Methods:
Fifteen consecutive gastroduodenal perforations for ulcer were recorded in the HIS of a single institution. Reports were analyzed and classified according to the following signs: Was a pneumoperitoneum detected? Was there mention of a perforation site, and how was it depicted (axial or reformatted slices, thin or thick slices)? What were the other described features, including peritoneal fluid, abdominal fat blurring, and bowel wall thickening?
Results:
All patients had a gastroduodenal perforation. MDCT identified pneumoperitoneum in 15 of 15 cases as compared with three of nine cases for plain films. The perforation site was seen in eight of 15: it was identified as a defect in the parietal wall (gastroduodenal). Six of eight cases were depicted in axial view. Two of them were only seen on MPR, coronal or sagittal view.
Conclusion:
MDCT improves the detection rate of pneumoperitoneum and provides critical data for locating the perforation using direct and indirect signs. Multiplanar images seem to improve radiologists' confidence.
Insights
Multidetector computed tomography (MDCT) significantly enhances the early detection of gastroduodenal perforation by improving pneumoperitoneum identification. This advanced imaging technique aids in precisely locating the perforation site, offering critical data for timely diagnosis and treatment.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Pathology
Background:
- Gastroduodenal perforation is a critical condition requiring prompt diagnosis.
- Early detection is crucial for effective management and improved patient outcomes.
- Traditional imaging methods may have limitations in identifying subtle signs of perforation.
Purpose of the Study:
- To evaluate the efficacy of multidetector computed tomography (MDCT) in the early detection of gastroduodenal perforation.
- To compare the diagnostic performance of MDCT with conventional imaging techniques.
Main Methods:
- A retrospective analysis of 15 consecutive gastroduodenal perforation cases.
- Review of MDCT reports for specific signs: pneumoperitoneum, perforation site depiction, peritoneal fluid, abdominal fat blurring, and bowel wall thickening.
- Comparison of MDCT findings with plain film radiography where available.
Main Results:
- MDCT successfully identified pneumoperitoneum in all 15 cases (100%), compared to 3 of 9 cases (33%) with plain films.
- The perforation site was visualized in 8 of 15 patients, with axial views being most common.
- Multiplanar reformatted (MPR) images were essential for visualizing the perforation in 2 cases.
Conclusions:
- MDCT significantly improves the detection rate of pneumoperitoneum in gastroduodenal perforation.
- MDCT provides crucial direct and indirect signs for accurate perforation site localization.
- The use of multiplanar imaging enhances radiologist confidence in diagnosing gastroduodenal perforations.
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