MDCT Findings in Gastrointestinal Perforations and the Predictive Value according to the Site of Perforation.

Stefania Romano,Warissara Jutidamrongphan,Marta Puglia,Khanin Khanungwanitkul,Carmela Somma,Daniela Pacella,Francesco Esposito,Felice Pirozzi,Claudio Mauriello,Antonio Sciuto

doi:10.3390/tomography8020056

Abstract

Background: Gastrointestinal perforations are a frequent cause of acute abdominal symptomatology for patients in the emergency department. The aim of this study was to investigate the findings of multidetector-row computed tomography of gastrointestinal perforations and analyze the impact of any imaging signs on the presurgical identification of the perforation site. Methods: We retrospectively reviewed emergency MDCT findings of 93 patients submitted to surgery for gastrointestinal perforation at two different institutions. Two radiologists separately reviewed the emergency MDCT examinations performed on each patient, before and after knowing the surgical diagnosis of the perforation site. A list of findings was considered. Positive predictive values were estimated for each finding with respect to each perforation site, and correspondence analysis (CA) was used to investigate the relationship between the findings and each of the perforation types. Results: We did not find inframesocolic free air in sigmoid colorectal perforations, and in rare cases, only supramesocolic free fluid in gastroduodenal perforations was found. A high PPV of perivisceral fat stranding due to colonic perforation and general distension of upstream loops and collapse of downstream loops were evident in most patients. Conclusions: Our data could offer additional information on the perforation site in the case of doubtful findings to support surgeons, especially in planning a laparoscopic approach.

Highlights

Gastrointestinal (GI) perforations are common surgical emergencies, accounting for approximately 3% of acute abdomen syndrome cases [1]
We found only inframesocolic free air in 20% of cases but with a high PPV (67%)
Our results appear interesting regarding the MDCT findings according to the site of perforation, adding some more new information to what is already known and has been reported in the radiologic literature

Summary

Introduction

Gastrointestinal (GI) perforations are common surgical emergencies, accounting for approximately 3% of acute abdomen syndrome cases [1]. They consist of discontinuities of the GI wall that allow the intestinal lumen and the extraluminal space to communicate. Breaches can appear due to different causes, such as peptic ulcers, inflammatory bowel disease, blunt or penetrating trauma, iatrogenic factors, foreign bodies or neoplasms [2–5]. Diagnosis of a GI tract perforation, together with identification of the site and cause, can facilitate treatment and improve prognosis, having a great impact on therapeutic management, including the type of surgery or a focused conservative choice [6]. Clinical diagnosis of the exact site of GI tract perforation may be difficult, as the clinical signs and symptoms may be nonspecific. The role of the emergency radiologist appears crucial, as the final diagnosis is mainly based on imaging results, on CT [7]

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