Radiologic evaluation of suspected gastrointestinal perforations

Perforation of the alimentary tract may occur spontaneously in various gastrointestinal diseases or develop due to an ingested foreign body, iatrogenic complication, and blunt or penetrating injuries. The detection of extraluminal air on radiographs of the chest or abdomen is often the initial clue to the diagnosis. It may not, however, be visible when the perforation is small, rapidly sealed, or well contained. Further evaluation by special radiographic techniques, gastrointestinal studies using contrast media, or CT examination can demonstrate the site and nature of the perforation. This article reviews the clinical features and methods for radiologic assessment of suspected perforations involving the upper gastrointestinal tract, small bowel, or colon and rectum.