Abstract
Purpose
The purpose of this study was to evaluate the computed tomography (CT) signs of free and covered small-bowel perforations and the potential of CT in recognising the aetiology.
Materials and methods
Thirty-five patients with surgically proven small-bowel perforation were retrospectively evaluated. Fundamental signs (extraluminal air, solution of continuity) and secondary signs (thickening of the mesentery, free or perilesional fluid, wall thickening) were considered.
Results
CT alterations were found in 31/35 (88.6 %) patients: extraluminal air (30/35, 85.7 %), solution of continuity (11/35, 31.4 %), intra-abdominal fluid (27/35, 77.1 %), thickening of the mesentery (20/35, 57.1 %), and wall thickening (14/35, 40 %). In 25/35 cases (71.4 %) pneumoperitoneum was detected, associated with secondary signs (23/25, 82 %), confirmed as free perforations at surgery. In 5/35 patients (14.2 %), peri-intestinal air bubbles and secondary signs were evident, while in 1/35 cases (2.8 %) only secondary signs were seen, namely covered perforations. In 4/35 patients (11.4 %) with a covered perforation, the CT scan was negative. The nature of the perforations was completely recognisable in 26/31 cases (83.9 %), partially identifiable in 4/31 (12.9 %), not evident in 1/31 (3.2 %).
Conclusion
CT investigation is essential in the recognition of a small-bowel perforation and in the definition of its nature.
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References
Zissin R, Osadchy A, Gayer G (2009) Abdominal CT findings in small bowel perforation. Br J Radiol 82(974):162–171
Mahajan G, Kotru M, Sharma R et al (2011) Usefulness of histopathological examination in nontraumatic perforation of small intestine. J Gastrointest Surg 15:1837–1841
Kim HC, Shin HC, Park SJ et al (2004) Traumatic bowel perforation: analysis of CT findings according to the perforation site and the elapsed time since accident. Clin Imaging 28:334–339
Kimchi NA, Broide E, Shapiro M et al (2002) Non-traumatic perforation of the small intestine. Report of 13 cases and review of the literature. Hepatogastroenterology 49:1017–1022
Giancarlo Dal Pozzo (1999) Compendio di tomografia computerizzata e TC spirale. UTET Ed
Urban BA, Fishman EK (2000) Tailored helical CT evaluation of acute abdomen. Radiographics 20:725–749
Furukawa A, Sakoda M, Yamasaki M et al (2005) Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imaging 30:524–534
Saku M, Yoshimitsu K, Murakami J et al (2006) Small bowel perforation resulting from blunt abdominal trauma: interval change of radiological characteristics. Radiat Med 24:358–364
Singh JP, Steward MJ, Booth TC et al (2010) Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl 92:182–188
Herlinger H, Maglinte D, Birnbaum B et al (2001) Clinical imaging of the small intestine. Springer-Verlag, Berlin, p 73
Stapakis JC, Thickman D (1992) Diagnosis of pneumoperitoneum: abdominal CT vs. upright chest film. J Comput Assist Tomogr 16:713–716
Jeffrey RB, Federle MP, Wall S (1983) Value of computed tomography in detecting occult gastrointestinal perforation. J Comput Assist Tomogr 7:825–827
Cho KC, Baker SR (1994) Extraluminal air: diagnosis and significance. Radiol Clin N Am 32:829–844
De Meo JH, Fulcher AS, Austin RF Jr (1995) Anatomic CT demonstration of the peritoneal spaces, ligaments, and mesenteries: normal and pathologic processes. Radiographics 15:755–770
Hainaux B, Agneessens E, Bertinotti R et al (2006) Accuracy of MDCT in predicting site of gastrointestinal tract perforation. Am J Roentgenol 187:1179–1183
Ghekiere O, Lesnik A, Millet I et al (2007) Direct visualization of perforation sites in patients with a non-traumatic free pneumoperitoneum: added diagnostic value of thin transverse slices and coronal and sagittal reformations for multi-detector CT. Eur Radiol 17:2302–2309
Lee H, Vibhakar SD, Bellon EM (1983) Gastrointestinal perforation: early diagnosis by computed tomography. J Comput Assist Tomogr 7:226–229
Thornton E, Lala MM, Siewert B et al (2011) Patterns of fat stranding. Am J Roentgenol 197:W1–W14
Mindelzun RE, Jeffrey RB Jr, Lane MJ et al (1996) The misty mesentery on CT: differential diagnosis. AJR Am J Roentgenol 167:61–65
Okino Y, Kiyosue H, Mori H et al (2001) Root of the small bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radiographics 21:1475–1490
Coakley FV, Hricak H (1999) Imaging of peritoneal and mesenteric disease: key concepts for the clinical radiologist. Clin Radiol 54:563–574
Angelelli G, Macarini L (1992) TC del tratto gastoenterico. Ed. Minerva medica
Brody JM, Leighton DB, Murphy BL et al (2000) CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis. Radiographics 20:1525–1536
Gayer G, Petrovitch I, Jeffrey RB (2011) Foreign objects encountered in the abdominal cavity at CT. Radiographics 31:409–428
Coulier B, Tancredi MH, Ramboux A (2004) Spiral CT and multidetector-row CT diagnosis of perforation of the small intestine caused by ingested foreign bodies. Eur Radiol 14:1918–1925
Rajagopalan AE, Pickleman J (1982) Free perforation of the small intestine. Ann Surg 196:576–579
Ghahremani GG (1993) Radiologic evaluation of suspected gastrointestinal perforations. Radiol Clin N Am 31:1219–1234
Maniatis V, Chryssikopoulos H, Roussakis A et al (2000) Perforation of the alimentary tract: evaluation with computed tomography. Abdom Imaging 25:373–379
Angelelli G, Moschetta M, Cosmo T et al (2012) CT diagnosis of the nature of bowel obstruction: morphological evaluation of the transition point. Radiol Med 117:749–758
Angelelli G, Moschetta M, Binetti F et al (2010) Prognostic value of MDCT in malignant large-bowel obstructions. Radiol Med 115:747–757
Moschetta M, Stabile Ianora AA, Pedote P et al (2009) Prognostic value of multidetector computed tomography in bowel infarction. Radiol Med 114:780–791
Catalano O (1996) Computed tomography in the study of gastrointestinal perforation. Radiol Med 91:247–252
Pinto A, Grassi R, Rossi G et al (1998) Computed tomography in the diagnosis of jejuno–ileal perforation. Personal experience. Radiol Med 96:602–606
Schmutz GR (1996) Imagerie de l’abdomen aigu. Masson Ed
Sota O, Tomohiro F, Koji H et al (2010) 64-slice multidetector computed tomography evaluation of gastrointestinal tract perforation site: detectability of direct findings in upper and lower GI tract. Eur Radiol 20:1396–1403
Grassi R, Romano S, Pinto A et al (2004) Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol 50:30–36
Conflict of interest
Marirosa Cristallo Lacalamita, Marco Moschetta, Maria Elisabetta Mancini, Arnaldo Scardapane, Giuseppe Angelelli declare no conflict of interest.
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Lacalamita, M.C., Moschetta, M., Mancini, M.E. et al. Role of CT in the diagnosis of jejunal–ileal perforations. Radiol med 119, 651–657 (2014). https://doi.org/10.1007/s11547-013-0375-7
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DOI: https://doi.org/10.1007/s11547-013-0375-7