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

Abstract

The incremental diagnostic value of adding 1.25-mm slices and coronal and sagittal reformatting to 5-mm axial reconstructions for direct visualization of the perforation site in patients with non-traumatic free pneumoperitoneum was assessed. Forty patients with non-traumatic bowel perforation and free pneumoperitoneum underwent computed tomography (CT). The perforation was gastroduodenal in 18 patients and involved the small or large bowel in 22 patients. Transverse scans were reconstructed with 5-mm thick sections at 5-mm intervals and 1.25-mm-thick sections at 1.25-mm intervals. The second data set was reformatted coronally and sagittaly with 3-mm-thick sections at 3-mm intervals. Three independent blinded readers interpreted 5-mm transverse scans, then combined 1.25-mm and 5-mm-transverse scans, and then combined transverse, coronal and sagittal scans. The rate of identification of the perforation site ranged from 43% to 53% with the combined axial, sagittal and coronal scans, from 28% to 48% with the 1.25- and 5-mm transverse scans, and from 5% to 20% only with the 5-mm thick transverse scans. The agreement between readers was significantly higher with thin slices and reformatting. The use of 1.25-mm axial slices and reformations intrinsically contained more useful diagnostic information than 5-mm axial slices alone for diagnosis of the perforation site in patients with pneumoperitoneum.

Can multidetector CT detect the site of gastrointestinal tract injury in trauma? – A retrospective study

“…Only Kim et al (21) and Rodriguez et al (28) studied GIT perforations exclusively in trauma patients, but they did not evaluate multiple site GIT trauma. Unlike nontraumatic gastrointestinal perforations, which usually occur in a single location and are associated with etiologic clues to localize the site of pathology (i.e., appendicolith, inflammatory phlegmon, abdominal mass), gastrointestinal tract injuries in trauma can be masked or missed due to presence of other organ injuries (17,26,31,33). Second, oral contrast is not routinely administered in acute trauma compared with evaluation in nontraumatic cases.…”

“…juries (17). Previous studies, conducted predominantly in nontraumatic populations, have documented that CT can accurately predict the site of GIT perforation (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

“…Ghekiere ve arkadaşları [17] 8 ve 16-slice MDBT ile yaptıkları çalışmada 40 hastanın BT görüntülerini geriye dönük olarak değerlendirmişlerdir. Hiçbir hastaya oral kontrast verilmemiş, 35 hastaya intravenöz kontrast madde verilmiştir.…”

“…İntravenöz kontrast madde kullanılmayan hastalarda ise %6 gibi düşük bir oran saptanmıştır. Ghekiere ve arkadaşlarının [17] çalış-masında üst gastrointestinal kanal perforasyonu olan hastalarda %72, alt gastrointestinal kanal perforasyonu olan hastalarda %36 oranında duvar devamsızlığı saptanmıştır. Bizim çalışmamızda üst gastrointestinal perforasyonlu hastaların %42,9'unda, alt gastrointestinal perforasyonu olan hastaların %13,6'sında duvar devamsızlığı saptandı.…”

Bowel Perforations

“…In our experience (Ghekiere et al 2007b), in a retrospective study including 40 patients with nontraumatic digestive perforations from various sites and causes, the utility of thin sections and reconstruction significantly allowed direct identification of the route of perforation. Identification was possible in 5-20% of the cases, depending on the readers, using 5-mm sections in the axial plane, in 28-48% of the cases using both 1-and 5-mm sections, and in 43-53% of the cases using both thin slices and sagittal coronal and axial planes.…”