CT in upper gastrointestinal tract perforations secondary to peptic ulcer disease

Abstract

Computed tomographic (CT) scans of 11 patients with perforations of the stomach or duodenum were reviewed to determine the variety and relative conspicuity of findings. Five patients had de novo presentation due to perforation of peptic ulcers, two had perforations at ulcer repair sites, and the remaining four patients had ulcer perforations following unrelated surgery. CT allowed recognition of at least one component of bowel perforation, such as extra-gastrointestinal gas and/or contrast, in most patients. In only three patients (27%), however, could these findings be specifically related to a perforation of the stomach or duodenum from the CT scans alone.

Direct visualization of perforation sites in patients with a non-traumatic free pneumoperitoneum: added diagnostic value of thin transverse slices and coronal and sagittal reformations for multi-detector CT

“…Furthermore, CT is often indicated when free air is seen but conventional radiography does not provide a clear view of the perforation site. However, detection of the actual perforation site is often challenging because the localization of free air is not necessarily correlated with this site [5,6]. If present, focal fluid, air, or inflammatory changes near the perforation site may facilitate its localization.…”

Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients

“…[1][2][3][4] Computed tomography (CT) is highly effective in this fi eld, [5][6][7][8][9] and the utility of CT in GI tract perforations due to peptic ulcer disease, diverticulitis, trauma, appendicitis, or Crohn's disease has been well documented. 5,7,[10][11][12][13][14][15][16][17][18][19] Amounts of extraluminal air too small for detection by conventional radiography can be demonstrated by CT. Indirect fi ndings of bowel perforation-phlegmon, abscess, peritoneal fl uid, the presence of an extraluminal foreign body-on CT can be also diagnostic clues pointing toward perforation.…”

Acute gastroduodenal peptic ulcer perforation: contrast-enhanced and thin-section spiral CT findings in 10 patients

“…In previous studies, CT has been associated with low accuracy in detecting the site of a GD ulcer perforation [2][3][4][5][6][7]. However, these studies, performed with conventional CT, had several limitations: 10-or 15-mm sections do not allow a precise depiction of the GD wall, sequential acquisition induces level shifts between adjacent slices, and there is an inability to obtain accurate GD wall enhancement.…”

“…Such management requires a definite diagnosis, which may be difficult to assess because endoscopic exploration or barium meal should be avoided in such conditions. Previous reports [2][3][4][5][6][7][8] have indicated the value of computed tomography (CT) for the detection of the pneumoperitoneum but have also emphasized the limits of this technique in demonstrating the site of perforation. Therefore, the diagnosis may be strongly suspected but not fully assessed.…”