Kei Takase MD, Presenter: Nothing to Disclose

Hiroya Rikimaru, Abstract Co-Author: Nothing to Disclose

Masahiro Tsuboi MD, Abstract Co-Author: Nothing to Disclose

Shoki Takahashi MD, Abstract Co-Author: Nothing to Disclose

Akihiro Sato MD, Abstract Co-Author: Nothing to Disclose

Takayuki Yamada MD, Abstract Co-Author: Nothing to Disclose

Tomonori Matsuura, Abstract Co-Author: Nothing to Disclose

Takahiro Metoki, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To assess the usefulness of multi-detector-row helical CT in detection of the site of gastrointestinal tract perforation.

During a three year period, MDCT findings of contiguous 70 patients (50 males, 20 females,age 20-92 y.o., mean 57.4) with surgically proven GI tract perforation was reviewed. Cases with post operative leakage at surgical anastomosis were excluded from this study. Causes of perforation were peptic ulcer (27), tumor (6), diverticulum (6), trauma (4), gall stone (3), foreign body (3), bowel inflammation (2), appendicitis (8), iatrogenic (2), and idiopathic (9). We used 4 or 8-detector-row helical CT to perform 2 or 3-mm collimation scanning with intravenous contrast material. Oral contrast was not used. Original axial data sets of 2 or 3-mm slice thickness with 1 or 1.5 mm intervals were evaluated by paging method. The CT diagnosis of presence of perforation was based on (a) free air in the abdomen, or (b) direct visualization of perforated site as focal defect of enhanced bowel wall. The CT criteria for identification of the site of perforation were as follows (a) Focal defect of enhanced bowel wall is directly visualized by paging method. (b) In the presence of free air, focal bowel abnormality which may cause perforation such as inflammatory bowel thickening, tumor, diverticulum, or inflammatory change of surrounding soft tissue, or uneven distribution of free air near the bowel was detected

GI tract perforation was detected in 67 of 70 cases (sensitivity 95.7%) by paging method interpretation of MDCT. Free air was detected in 56 of 67 cases (80%), and the remaining 11 cases were diagnosed only by direct visualization of perforation. The site of perforation was accurately diagnosed in 59 cases (84.3%). Focal defect of bowel wall was visualized in 46 cases. The sites of gastro-duodenal, jejuno-ileal, and colon perforation were accurately diagnosed in 100%, 41.7%, and 88.9% respectively.

MDCT with paging method evaluation could accurately detect the site of GI tract perforation as well as diagnose presence of perforation. Detection of focal defect of enhanced bowel wall is effective for diagnosis.

Takase, K, Rikimaru, H, Tsuboi, M, Takahashi, S, Sato, A, Yamada, T, Matsuura, T, Metoki, T, et al, , Detectability of the Site of Gastrointestinal Tract Perforation by MDCT.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4411883.html