Takanori Negishi, Presenter: Nothing to Disclose

Masanori Imuta MD, Abstract Co-Author: Nothing to Disclose

Yuka Murata, Abstract Co-Author: Nothing to Disclose

Tetsuya Matsukawa MD, Abstract Co-Author: Nothing to Disclose

Kazuo Awai MD, Abstract Co-Author: Nothing to Disclose

Yasuyuki Yamashita MD, Abstract Co-Author: Nothing to Disclose

To assess the value of multidetector-row computed tomography (MD-CT) in the diagnosis of perforation of the alimentary tract (AT).

During a 3-year period 165 patients with proven AT perforation underwent MD-CT within 1 week before surgery or endoscopy. Patients were 17-95 years old (mean = 67.5 years); 91 were men and 74 were women. We retrospectively reviewed these MD-CT scans to determine the signs of AT perforation. CT findings were correlated with surgical or endoscopic findings by three radiologists. Our goal was to establish the diagnosis of AT perforation and, if this was possible, to identify the site and cause of the AT wall rupture. The CT diagnosis of perforation was based on (a) direct findings of extraluminar air and (b) indirect findings of an abscess or an inflammatory mass surrounding an enterolith in the region of appendix or a bowel wall-related phlegmon or abscess with fluid in the mesentery or surrounding radiopaque foreign body.

Levels of perforation were the esophagus (10), stomach (25), duodenum (33), small bowel (15), appendix (26), and colon (56). Causes of perforation were peptic ulcer (50), appendicitis (34), diverticulitis (31), AT carcinoma (18), foreign body (11), Crohn disease (10), iatrogenic (3), trauma (1) and the others. The ruptured colonic wall was directly visualized in 69 cases (41.8%). The site of perforation was correctly predicted in 150 patients, the sensitivity was estimated to 90.9%.

MD-CT is a valuable method in the diagnosis of AT perforation. The diagnosis can be established rapidly, without patient preparation and with a high sensitivity.

Negishi, T, Imuta, M, Murata, Y, Matsukawa, T, Awai, K, Yamashita, Y, Multidetector-Row CT Findings Could Suggest Use of the Perforation Locus of the Alimentary Tract: Direct and Indirect Findings of Perforation in 165 Patients.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4419758.html