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Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

Hyun Cheol Kim1, Dal Mo Yang, Sang Won Kim

  • 1Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727, Republic of Korea, khcppp@khu.ac.kr.

European Radiology
|March 14, 2014
PubMed
Abstract

Insights

Multidetector computed tomography (MDCT) accurately predicts gastrointestinal (GI) perforation sites, especially in the stomach and duodenum. Diagnostic accuracy was high regardless of the time elapsed since perforation.

Area of Science:

  • Radiology
  • Gastroenterology
  • Surgical Imaging

Background:

  • Gastrointestinal (GI) tract perforation is a critical condition requiring prompt diagnosis.
  • Accurate localization of the perforation site is crucial for effective surgical management.
  • Multidetector computed tomography (MDCT) is a key imaging modality in evaluating acute abdominal conditions.

Purpose of the Study:

  • To assess the efficacy of MDCT in predicting the specific site of GI tract perforation.
  • To evaluate the influence of elapsed time on MDCT's perforation site prediction accuracy.
  • To identify specific CT findings indicative of perforation at different GI tract locations.

Main Methods:

  • A study involving 168 patients who underwent MDCT prior to laparotomy for GI perforation.
  • Patients were categorized into early (<7 hours) or late (≥7 hours) groups based on time elapsed.
  • Two independent reviewers analyzed MDCT scans for specific findings like extraluminal air, bowel wall changes, and fat stranding.

Main Results:

  • Overall diagnostic accuracy for perforation site prediction was high (over 91%) with excellent inter-reviewer agreement (kappa 0.86).
  • MDCT demonstrated superior accuracy (over 97%) for stomach and duodenum perforations.
  • Specific CT findings like focal bowel wall discontinuity and mottled extraluminal air bubbles were strong predictors for different perforation sites.

Conclusions:

  • MDCT is a reliable tool for accurately predicting upper GI tract perforation sites.
  • The accuracy of MDCT in predicting perforation sites is not significantly affected by the elapsed time.
  • Utilizing knowledge of specific CT findings enhances diagnostic accuracy for GI perforation.

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