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Evolution of imaging for abdominal perforation.
J P Singh1, M J Steward, T C Booth
1Department of Radiology, The Whittington Hospital, Royal Free and University College Medical School, London, UK.
Annals of the Royal College of Surgeons of England
|April 24, 2010
Summary
Computed tomography (CT) aids in identifying gastrointestinal (GI) perforation sites. Characteristic CT findings, including free gas and bowel wall changes, help in surgical planning.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Pathology
Background:
- Gastrointestinal (GI) perforation is a frequent surgical emergency.
- Computed tomography (CT) is the preferred imaging modality for diagnosing GI perforation.
- CT findings can be subtle and require careful interpretation.
Purpose of the Study:
- To review the role of CT in diagnosing GI perforation.
- To highlight characteristic CT appearances and diagnostic pitfalls.
- To emphasize the importance of CT in pre-operative evaluation.
Main Methods:
- A comprehensive literature search of MEDLINE and PubMed was conducted.
- The search focused on studies published before June 2009 using MeSH terms 'CT' and 'perforation'.
- Non-English literature was excluded from the review.
Main Results:
- CT accurately predicts the site of GI perforation across various etiologies (inflammatory, neoplastic, traumatic, iatrogenic).
- Key CT findings include free intraperitoneal gas or fluid, segmental bowel wall thickening, discontinuity, mesenteric stranding, and abscess formation.
- Subtle or indirect signs of perforation can occur, necessitating thorough analysis.
Conclusions:
- Characteristic CT features enable precise pre-operative assessment of GI perforation.
- Accurate CT interpretation is crucial for multidisciplinary patient management and surgical planning.
- Understanding CT findings improves diagnostic accuracy and guides surgical intervention.
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