Gastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies: oesophageal perforations can present with acute chest pain, odynophagia and vomiting, gastroduodenal perforations with acute severe abdominal pain, while colonic perforations tend to follow a slower progression course with secondary bacterial peritonitis or localised abscesses. A subset of patients may present with delayed symptoms, abscess mimicking an abdominal mass, or with sepsis. Direct multidetector computed tomography (MDCT) findings support the diagnosis and localise the perforation site while ancillary findings may suggest underlying conditions that need further investigation following primary repair of ruptured bowel. MDCT findings include extraluminal gas, visible bowel wall discontinuity, extraluminal contrast, bowel wall thickening, abnormal mural enhancement, localised fat stranding and/or free fluid, as well as localised phlegmon or abscess in contained perforations. The purpose of this article is to review the spectrum of MDCT findings encountered in GIT perforation and emphasise the MDCT and clinical clues suggestive of the underlying aetiology and localisation of perforation site.

Background Although diffusely abnormal white matter (DAWM) is commonly seen in multiple sclerosis (MS), it is rarely considered in clinical/imaging studies. Purpose To evaluate quantitative markers of microstructural changes in DAWM of patients with clinically isolated syndrome (CIS) and relapsing–remitting MS (RR‐MS) in relation to MS lesions and degree of neurocognitive impairment, by using a multi‐echo spin echo (MESE) Proton Density PD‐to‐T2 sequence. Study Type Prospective, cross‐sectional. Population Thirty‐seven RR‐MS patients, 33 CIS patients, and 52 healthy controls. Field Strength/Sequence 1.5 T/T1‐, T2‐weighted, fluid‐attenuated inversion recovery, and MESE sequences. Assessment Long T2, short T2, and myelin water fraction (MWF) values were estimated as indices of intra/extracellular water content and myelin content, respectively, in DAWM, posterior periventricular normal appearing white matter (NAWM), and focal MS lesions, classified according to their signal intensity on T1 sequences. Patients were, also, administered a battery of neuropsychological tests. Statistical Tests Comparisons of T2 and MWF values in DAWM, NAWM, and MS lesions were examined, using two‐way mixed analyses of variance. Associations of Grooved Pegboard performance with T2 and MWF values in DAWM and NAWM were assessed using Pearson correlation coefficients. Results T2 and MWF values of DAWM were intermediate between the respective values of NAWM and T1 hypointense focal lesions, while there was no difference between the respective values of DAWM and T1‐isointense lesions. T2 values in DAWM were strongly associated with visuomotor performance in CIS patients. Data Conclusion Intra/extracellular water and myelin water content of DAWM are similar to those of T1‐isointense lesions and predict visuomotor performance in CIS patients. Level of Evidence 2 Technical Efficacy Stage 2

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