Skip to main content
SpringerLink
Log in

Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients

  • ORIGINAL ARTICLE
  • Published:
Radiation Medicine Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to investigate how accurately we could diagnose the level of gastrointestinal (GI) tract perforation using multidetector computed tomography (MDCT).

Materials and methods

We reviewed 155 patients with surgically confirmed GI tract perforation. MDCT scans were obtained with eight-detector CT; 5 mm thick axial images and 2.5 mm thick coronal multiplanar reconstruction (MPR) images were generated for all patients. Contrast enhancement was performed in 44 of the 155 patients. Two board-certified radiologists reviewed the images for direct findings (free air, ruptured GI tract wall) and indirect findings (inflammatory changes, fluid collection, focal thickening of the GI tract wall) and attempted to identify the perforation site in each patient.

Results

Free air was seen in more than 95% of the patients with perforation at sites other than the appendix; free air was seen in 44% of patients with appendicitis. On contrast-enhanced CT performed in 44 patients, rupture of the wall of the GI tract was directly visualized in 14 (32%) on axial images only and in 23 (52%) on axial or MPR images, respectively. The perforation site was correctly diagnosed in 90% of the patients when the radiologists referred to both direct and indirect findings.

Conclusion

MDCT was valuable for identifying the presence and level of GI tract perforation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. KC Cho SR Baker (1994) ArticleTitleExtraluminal air: diagnosis and significance Radiol Clin North Am 32 829–44 Occurrence Handle8084998 Occurrence Handle1:STN:280:DyaK2czmslWruw%3D%3D

    PubMed  CAS  Google Scholar 

  2. MS Levine JD Scheiner SE Rubesin I Laufer H Herlinger (1991) ArticleTitleDiagnosis of pneumoperitoneum on supine abdominal radiographs AJR Am J Roentgenol 156 731–5 Occurrence Handle2003436 Occurrence Handle1:STN:280:DyaK3M7msFOhuw%3D%3D

    PubMed  CAS  Google Scholar 

  3. MG Phatak SJ Frank JJ Ellis (1984) ArticleTitleComputed tomography of bowel perforation Gastrointest Radiol 9 133–5 Occurrence Handle6745589 Occurrence Handle10.1007/BF01887819 Occurrence Handle1:STN:280:DyaL2c3mt1entA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. RP Rice WM Thompson RK Gedgaudas (1982) ArticleTitleThe diagnosis and significance of extraluminal gas in the abdomen Radiol Clin North Am 20 819–37 Occurrence Handle6758034 Occurrence Handle1:STN:280:DyaL3s%2FptF2jtQ%3D%3D

    PubMed  CAS  Google Scholar 

  5. GM Glazer JN Buy AA Moss HI Goldberg MP Federle (1981) ArticleTitleCT detection of duodenal perforation AJR Am J Roentgenol 137 333–6 Occurrence Handle6789642 Occurrence Handle1:STN:280:DyaL3M3lt1KjtA%3D%3D

    PubMed  CAS  Google Scholar 

  6. RB Jeffrey MP Federle S Wall (1983) ArticleTitleValue of computed tomography in detecting occult gastrointestinal perforation J Comput Assist Tomogr 7 825–7 Occurrence Handle6886134 Occurrence Handle10.1097/00004728-198310000-00013 Occurrence Handle1:STN:280:DyaL3s3ptFyjug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. V Maniatis H Chryssikopoulos A Roussakis C Kalamara S Kvadias A Papadopoulos et al. (2000) ArticleTitlePerforation of the alimentary tract: evaluation with computed tomography Abdom Imaging 25 373–9 Occurrence Handle10926189 Occurrence Handle10.1007/s002610000022 Occurrence Handle1:STN:280:DC%2BD3M%2Fjs1Cqsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  8. JC Stapakis D Thickman (1992) ArticleTitleDiagnosis of pneumoperitoneum: abdominal CT vs. upright chest film J Comput Assist Tomogr 16 713–6 Occurrence Handle1522261 Occurrence Handle10.1097/00004728-199209000-00008 Occurrence Handle1:STN:280:DyaK38zpsFajuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  9. KW Yeung MS Chang CP Hsiao JF Huang (2004) ArticleTitleCT evaluation of gastrointestinal tract perforation Clin Imaging 28 329–33 Occurrence Handle15471663 Occurrence Handle10.1016/S0899-7071(03)00204-3

    Article  PubMed  Google Scholar 

  10. CH Chen HS Huang CC Yang YH Yeh (2001) ArticleTitleThe features of perforated peptic ulcers in conventional computed tomography Hepatogastroenterology 48 1393–6 Occurrence Handle11677972 Occurrence Handle1:STN:280:DC%2BD3MrntFagtw%3D%3D

    PubMed  CAS  Google Scholar 

  11. PJ Fultz J Skucas SL Weiss (1992) ArticleTitleCT in upper gastrointestinal tract perforations secondary to peptic ulcer disease Gastrointest Radiol 17 5–8 Occurrence Handle1544559 Occurrence Handle10.1007/BF01888496 Occurrence Handle1:STN:280:DyaK387osVSrtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  12. P Ongolo-Zogo O Borson P Garcia L Gruner PJ Valette (1999) ArticleTitleAcute gastroduodenal peptic ulcer perforation: contrast-enhanced and thin-section spiral CT findings in 10 patients Abdom Imaging 24 329–32 Occurrence Handle10390552 Occurrence Handle10.1007/s002619900509 Occurrence Handle1:STN:280:DyaK1MzitFKntg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  13. TA Foley Ft Earnest MA Nathan DM Hough HJ Schiller TL Hoskin (2005) ArticleTitleDifferentiation of nonperforated from perforated appendicitis: accuracy of CT diagnosis and relationship of CT findings to length of hospital stay Radiology 235 89–96 Occurrence Handle15749978 Occurrence Handle10.1148/radiol.2351040310

    Article  PubMed  Google Scholar 

  14. MM Horrow DS White JC Horrow (2003) ArticleTitleDifferentiation of perforated from nonperforated appendicitis at CT Radiology 227 46–51 Occurrence Handle12615997 Occurrence Handle10.1148/radiol.2272020223

    Article  PubMed  Google Scholar 

  15. JE Jacobs BA Birnbaum M Macari AJ Megabow G Israel DD Maki et al. (2001) ArticleTitleAcute appendicitis: comparison of helical CT diagnosis focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material Radiology 220 683–90 Occurrence Handle11526267 Occurrence Handle10.1148/radiol.2202001557 Occurrence Handle1:STN:280:DC%2BD3MvotlahtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. C Lohrmann N Ghanem G Pache F Makowiec E Kotter M Langer (2005) ArticleTitleCT in acute perforated sigmoid diverticulitis Eur J Radiol 56 78–83 Occurrence Handle16168267 Occurrence Handle10.1016/j.ejrad.2005.03.003

    Article  PubMed  Google Scholar 

  17. AA Lozon JH Duff (1976) ArticleTitleAcute perforation of the colon Can J Surg 19 48–51 Occurrence Handle1245007 Occurrence Handle1:STN:280:DyaE28%2FptVSrsA%3D%3D

    PubMed  CAS  Google Scholar 

  18. T Miki S Ogata M Uto T Nakazono M Urata R Ishibe et al. (2004) ArticleTitleMultidetector-row CT findings of colonic perforation: direct visualization of ruptured colonic wall Abdom Imaging 29 658–62 Occurrence Handle15162233 Occurrence Handle10.1007/s00261-003-0159-y Occurrence Handle1:STN:280:DC%2BD2crks1ygsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. P Goodman B Raval GD Potter (1989) ArticleTitleSpontaneous free perforation of the ileum in Crohn disease: CT demonstration Comput Med Imaging Graph 13 473–5 Occurrence Handle2598157 Occurrence Handle10.1016/0895-6111(89)90289-9 Occurrence Handle1:STN:280:DyaK3c%2FptVCjtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  20. A Furukawa M Sakoda M Yamasaki N Kono T Tanaka N Nitta et al. (2005) ArticleTitleGastrointestinal tract perforation: CT diagnosis of presence, site, and cause Abdom Imaging 30 524–34 Occurrence Handle16096870 Occurrence Handle10.1007/s00261-004-0289-x Occurrence Handle1:STN:280:DC%2BD2MrkvFSrsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  21. MA Meyers (2000) Intraperitoneal spread of malignancies MA Meyers (Eds) Dynamic radiology of the abdomen: normal and pathologic anatomy EditionNumber5th edition Springer-Verlag New York 152–6

    Google Scholar 

  22. K Nikolaou T Flohr A Knez C Rist B Wintersperger T Johnson MF Reiser et al. (2004) ArticleTitleAdvances in cardiac CT imaging: 64-slice scanner Int J Cardiovasc Imaging 20 535–40 Occurrence Handle15856639 Occurrence Handle10.1007/s10554-004-7015-1

    Article  PubMed  Google Scholar 

  23. TJ Vrtiska JG Fletcher CH McCollough (2005) ArticleTitleState-of-the-art imaging with 64-channel multidetector CT angiography Perspect Vasc Surg Endovasc Ther 17 3–8 Occurrence Handle15952689 Occurrence Handle10.1177/153100350501700102

    Article  PubMed  Google Scholar 

  24. HA Shaffer SuffixJr (1992) ArticleTitlePerforation and obstruction of the gastrointestinal tract: assessment by conventional radiology Radiol Clin North Am 30 405–26 Occurrence Handle1535864

    PubMed  Google Scholar 

  25. BM Miller A Kumar (1990) ArticleTitleNeonatal duodenal perforation J Pediatr Gastroenterol Nutr 11 407–10 Occurrence Handle2246726 Occurrence Handle1:STN:280:DyaK3M%2FmtFagtQ%3D%3D Occurrence Handle10.1097/00005176-199010000-00022

    Article  PubMed  CAS  Google Scholar 

  26. JS Miller KM Itani MD Oza MJ Wall (1997) ArticleTitleGastric rupture with tension pneumoperitoneum: a complication of difficult endotracheal intubation Ann Emerg Med 30 343–6 Occurrence Handle9287899 Occurrence Handle10.1016/S0196-0644(97)70173-2 Occurrence Handle1:STN:280:DyaK2svjsVSisQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  27. GG Ghahremani (1993) ArticleTitleRadiologic evaluation of suspected gastrointestinal perforations Radiol Clin North Am 31 1219–34 Occurrence Handle8210347 Occurrence Handle1:STN:280:DyaK2c%2Fit12gtQ%3D%3D

    PubMed  CAS  Google Scholar 

  28. PA Schneider H Hauser (1982) ArticleTitleDiagnosis of alimentary tract perforation by CT Eur J Radiol 2 197–201 Occurrence Handle7128602 Occurrence Handle1:STN:280:DyaL3s%2Fislentg%3D%3D

    PubMed  CAS  Google Scholar 

  29. AA Jabra EI Shalaby-Rana EK Fishman (1997) ArticleTitleCT of appendicitis in children J Comput Assist Tomogr 21 661–6 Occurrence Handle9216780 Occurrence Handle10.1097/00004728-199707000-00028 Occurrence Handle1:STN:280:DyaK2szlvFyltg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  30. EK Paulson TA Jaffe J Thomas JP Harris RC Nelson (2004) ArticleTitleMDCT of patients with acute abdominal pain: a new perspective using coronal reformations from submillimeter isotropic voxels AJR Am J Roentgenol 183 899–906 Occurrence Handle15385279

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Masanori Imuta, Kazuo Awai, Yoshiharu Nakayama, Yuka Murata & Yasuyuki Yamashita

  2. Kumamoto Regional Medical Center, Kumamoto, Japan

    Chiaki Asao & Tetsuya Matsukawa

Authors
  1. Masanori Imuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuo Awai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshiharu Nakayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuka Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chiaki Asao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tetsuya Matsukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuyuki Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masanori Imuta.

About this article

Cite this article

Imuta, M., Awai, K., Nakayama, Y. et al. Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients. Radiat Med 25, 113–118 (2007). https://doi.org/10.1007/s11604-006-0112-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-006-0112-4

Key words

Search

Navigation