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Updated: May 4, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Role of CT in the diagnosis of jejunal-ileal perforations
Marirosa Cristallo Lacalamita1, Marco Moschetta, Maria Elisabetta Mancini
1DIM-Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy, marirosacristallo@alice.it.
Purpose:
The purpose of this study was to evaluate the computed tomography (CT) signs of free and covered small-bowel perforations and the potential of CT in recognising the aetiology.
Materials And Methods:
Thirty-five patients with surgically proven small-bowel perforation were retrospectively evaluated. Fundamental signs (extraluminal air, solution of continuity) and secondary signs (thickening of the mesentery, free or perilesional fluid, wall thickening) were considered.
Results:
CT alterations were found in 31/35 (88.6%) patients: extraluminal air (30/35, 85.7%), solution of continuity (11/35, 31.4%), intra-abdominal fluid (27/35, 77.1%), thickening of the mesentery (20/35, 57.1%), and wall thickening (14/35, 40%). In 25/35 cases (71.4%) pneumoperitoneum was detected, associated with secondary signs (23/25, 82%), confirmed as free perforations at surgery. In 5/35 patients (14.2%), peri-intestinal air bubbles and secondary signs were evident, while in 1/35 cases (2.8%) only secondary signs were seen, namely covered perforations. In 4/35 patients (11.4%) with a covered perforation, the CT scan was negative. The nature of the perforations was completely recognisable in 26/31 cases (83.9%), partially identifiable in 4/31 (12.9%), not evident in 1/31 (3.2%).
Conclusion:
CT investigation is essential in the recognition of a small-bowel perforation and in the definition of its nature.
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