Olivier Ghekiere MD, Presenter: Nothing to Disclose

Alvian Lesnik MD, Abstract Co-Author: Nothing to Disclose

Denis Hoa MD, Abstract Co-Author: Nothing to Disclose

Guillaume Laffargue MD, Abstract Co-Author: Nothing to Disclose

Claire Uriot MD, Abstract Co-Author: Nothing to Disclose

Patrice Taourel MD, Abstract Co-Author: Nothing to Disclose

To determine whether gastro-duodenal ulcer perforations in patients with a non-traumatic free pneumoperitoneum can be differentiated from other causes of gastrointestinal (GI) perforations and to identify computed tomographic (CT) features with a high positive or negative predictive value (PPV/NPV) for this diagnosis.

CT-scans of 84 patients with documented non-traumatic free pneumoperitoneum were blindly reviewed. According to surgical data, the cause of perforation was a gastro-duodenal ulcer perforation in 37 patients and a small or large bowel perforation of various causes in 47 patients. We evaluated the incidence of direct visualization of the perforation site and assessed the indirect findings, including the presence, amount and localisation of free peritoneal air and ascites in the peritoneal cavity, the thickness of the gastrointestinal wall, fat stranding along the gastrointestinal tract, mechanic occlusion, ileus, enhancement of the peritoine, fecal peritonitis, a phlegmon or abscess, adenopathy, and parietal and venous pneumatosis.

The perforation site was directly visualized in 59% of the patients with gastro-duodenal ulcer perforation and in 26% of the patients with other causes of GI perforation. Indirect findings with a high PPV for gastro-duodenal ulcer perforation included local fluid between the duodenum and the pancreatic head (92%) and local gastro-duodenal wall thickening (78%). Indirect findings with a high NPV for gastro-duodenal ulcer perforation included free peritoneal air in the intersigmoid recess (89%), in the right (77%) and left (78%) paracolic gutters, inflammation of parasigmoid fat (100%), fecal peritonitis (100%), phlegmon or abscess (100%) and the absence of free peritoneal air in the left subphrenic space (90%).

CT-scan allowed direct visualization of the perforation site in 59% of patients with gastro-duodenal ulcer perforation. When the gastro-duodenal perforation site was not visible, some indirect findings were helpful to affirm or rule out the diagnosis of a gastro-duodenal ulcer perforation in patients with a non-traumatic free pneumoperitoneum.

Ghekiere, O, Lesnik, A, Hoa, D, Laffargue, G, Uriot, C, Taourel, P, Value of CT in the Diagnosis of the Cause of Gastrointestinal Tract Perforation.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4413911.html