IDENTIFICATION OF THE AETIOLOGY OF GASTROINTESTINAL PERFORATION: CLINICAL AND MDCT CLUES

A common medical emergency that has a high fatality rate between 30 and 50 % is perforation of the gastrointestinal tract (GIT). Oesophageal perforations can cause rapid chest pain, odynophagia, and vomiting gastroduodenal perforations can cause acute, severe abdominal pain and colonic perforations typically advance more slowly, resulting in localized abscesses or secondary bacterial peritonitis. Sepsis, an abscess that resembles an abdominal mass, or delayed symptoms are among the subsets of people who may present.

Ancillary findings may indicate underlying problems that require more examination after initial closure of the ruptured bowel, while direct multidetector computed tomography (MDCT) findings confirm the diagnosis and localize the perforation site. Findings from MDCT scans include extraluminal gas, gut wall thickening, apparent discontinuity in the intestinal wall, extraluminal contrast, aberrant mural enhancement, localized fat stranding and/or free fluid, and localized abscess or phlegmon in confined perforations.

In order to highlight the MDCT and clinical signs suggestive of the underlying aetiology and localization of the perforated site, this paper will examine the range of MDCT results found in GIT perforation.

I.            KEY POINTS

• Extraluminal gas, wall discontinuity or thickness, and fat stranding are signs of a GIT perforation.
• There is a spectrum of abundance to absence in pneumoperitoneum and extraluminal oral contrast.
• Additional observations include masses, faecal impaction, ischemia, foreign substances, and excessive wall thickening.
• The presence of a ruptured peptic ulcer suggests supramesocolic pneumoperitoneum and hyperenhancing gastric wall.
• Iatrogenic perforation is indicated by ascites and/or persistent or growing free air after surgery.