Abdominal CT findings in small bowel perforation

Area of Science:

• Radiology
• Gastroenterology
• Emergency Medicine

Background:

• Small bowel perforation is a life-threatening condition requiring prompt diagnosis and management.
• Clinical diagnosis of small bowel perforation is often challenging and unreliable.
• Computed tomography (CT) is the primary imaging modality for diagnosing acute abdominal conditions, including small bowel perforation.

Purpose of the Study:

• To illustrate the diverse computed tomography (CT) findings associated with small bowel perforation.
• To review the direct and secondary CT signs indicative of small bowel perforation.
• To correlate CT findings with various underlying clinical etiologies of small bowel perforation.

Main Methods:

• This is a pictorial review based on analysis of CT scans from patients with confirmed small bowel perforation.
• The review focuses on identifying and categorizing direct CT signs (e.g., extraluminal air, oral contrast) and secondary signs of bowel pathology.
• Illustrations of representative CT images are used to demonstrate findings.

Main Results:

• Direct CT signs of small bowel perforation include the presence of extraluminal air and oral contrast material within the abdomen.
• Secondary CT findings, such as bowel wall thickening, mesenteric stranding, and fluid collections, are frequently observed.
• Various clinical entities can lead to small bowel perforation, each potentially presenting with distinct CT appearances.

Conclusions:

• Computed tomography (CT) is indispensable for the accurate diagnosis of small bowel perforation.
• Recognizing specific direct and secondary CT features is crucial for identifying perforation and its potential causes.
• This pictorial review serves as a visual guide for radiologists and clinicians managing patients with suspected small bowel perforation.