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Springer Science+Business Media New York 2014 Published online: 2 March 2014
Abdom Imaging (2014) 39:802823 DOI: 10.1007/s00261-014-0110-4
Abdominal
Imaging
From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography
Andrew J. Del Gaizo,1 Chandana Lall,2 Brian C. Allen,1 John R. Leyendecker1
1Department of Radiology, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA
2Department of Radiology, University of California Irvine Medical Center, Orange, CA, USA
Abstract
Gastrointestinal (GI) tract perforation is a life-threatening condition that can occur at any site along the alimentary tract. Early perforation detection and intervention signicantly improves patient outcome. With a high sensitivity for pneumoperitoneum, computed tomography (CT) is widely accepted as the diagnostic modality of choice when a perforated hollow viscus is suspected. While conrming the presence of a perforation is critical, clinical management and surgical technique also depend on localizing the perforation site. CT is accurate in detecting the site of perforation, with segmental bowel wall thickening, focal bowel wall defect, or bubbles of extraluminal gas concentrated in close proximity to the bowel wall shown to be the most specic ndings. In this article, we will present the causes for perforation at each site throughout the GI tract and review the patterns that can lead to prospective diagnosis and perforation site localization utilizing CT images of surgically proven cases.
Key words: GastrointestinalPerforationComputed tomography
Gastrointestinal (GI) tract perforation is a life-threatening condition that can occur at any site along the alimentary tract. The standard management is prompt surgical intervention, with patient morbidity and mortality rising signicantly when diagnosis and treatment are delayed [1]. With delayed management, sepsis and multi-organ failure result in nearly 75% of perforation cases and the mortality rate approaches 30% [13]. In contrast, early perforation detection and intervention
significantly improves patient outcome. With a high sensitivity for pneumoperitoneum, computed tomography (CT) is widely accepted as the diagnostic modality of choice when a perforated hollow viscus is suspected [46].
Direct ndings on CT which conrm the presence of a perforation include focal bowel wall discontinuity, extraluminal gas, and extraluminal enteric contrast (when administered). Indirect signs of bowel perforation on CT include segmental bowel wall thickening, abnormal bowel wall enhancement, perivisceral fat stranding or uid, and abscess [4, 712].
While conrming...