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Emergency Radiology

, Volume 22, Issue 3, pp 315–327 | Cite as

The emergency room diagnosis of gastrointestinal tract perforation: the role of CT

  • Samuel Borofsky
  • Myles Taffel
  • Nadia Khati
  • Robert Zeman
  • Michael Hill
Pictorial Essay

Abstract

Computed tomography (CT) plays an important role in the evaluation of patients presenting to the emergency department with a suspected spontaneous gastrointestinal tract (GIT) perforation. Prospective identification of the site of perforation helps the emergency department physician plan the appropriate treatment in a potentially unstable patient. The purpose of this pictorial essay is to review the CT approach a radiologist should take when evaluating the patient with suspected perforation in the emergent setting. A series of patients presenting to the emergency department with surgically proven GIT perforations were retrospectively reviewed, and key images were obtained. For the purposes of this review, the anatomy of the abdominal cavity in relation to sites of GIT perforation will be discussed. CT findings of perforation will be described, including free intraperitoneal/extraperitoneal air, bowel wall discontinuity, and localized inflammatory changes. The use of a bone window setting to increase the free air conspicuity will be emphasized. The mimics of pneumoperitoneum will be demonstrated, including pneumothorax, pneumomediastinum, and venous air. Using a systematic approach, CT can precisely determine the presence and site of a gastrointestinal perforation in a majority of patients. This greatly assists the surgeon in planning the correct surgical approach.

Keywords

Gastrointestinal tract Perforation Free air Pneumoperitoneum 

Notes

Conflict of interest

We wish to confirm that there are no known conflicts of interest associated with this publication, and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing, we confirm that we have followed the regulations of our institutions concerning intellectual property.

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Copyright information

© American Society of Emergency Radiology 2014

Authors and Affiliations

  • Samuel Borofsky
    • 1
  • Myles Taffel
    • 1
  • Nadia Khati
    • 1
  • Robert Zeman
    • 1
  • Michael Hill
    • 1
  1. 1.Department of RadiologyThe George Washington University HospitalWashingtonUSA

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