Perforated tumours in the gastrointestinal tract: CT findings and clinical implications

Abstract

ABSTRACT. Perforation usually requires emergency surgery and may affect the prognosis of patients with gastrointestinal tumours. Accurate pre-operative diagnosis of these conditions is important because proper management such as curative surgical treatment may be needed. The aims of this article are to illustrate CT appearances of perforated tumours of the gastrointestinal tract and to discuss their impact on clinical management.

CT findings in acute peritonitis: a pattern-based approach

“…In fact, peritoneal carcinomatosis may be due to a primary abdominal tumor, such as gastric or colorectal or pancreatic or ovarian cancer (20), or an extra-abdominal tumor, such as breast carcinoma, melanoma, or lung cancer (21). Usually diffuse peritoneal involvement is characterized by parietal and visceral nodular implants which cover and encase the small bowel loops, leading to obstruction, and occasionally to perforation.…”

“…Colon adenocarcinoma can lead to perforation proximal to the mass. The most commonly involved segments to perforate include the sigmoid colon and the cecum (21). On CT, identifying signs of perforation in the setting of irregular colonic wall thickening and infiltrative pericolonic soft tissue can favor the diagnosis.…”

Unsuspected colorectal carcinoma on routine abdominopelvic computed tomography

“…(8,15) In these patients, it is important to evaluate for underlying CRC, which may be masked by the acute findings. …”

“…(8,15) Identifying the transition point as focal asymmetric irregular wall thickening or the presence of a mass representing CRC is crucial to establishing the cause of perforation, as perforation is associated with a higher chance of metastasis. (15) Perforation can occur secondary to tumour necrosis or from a closed-loop obstruction in which there is raised intracolonic pressure proximal to the tumour and a competent ileocaecal valve. (8,15) Common sites of perforation are the sigmoid colon and caecum, and the rate of perforation in the left hemicolon is higher than that in the right due to the smaller diameter.…”

“…(15) Perforation can occur secondary to tumour necrosis or from a closed-loop obstruction in which there is raised intracolonic pressure proximal to the tumour and a competent ileocaecal valve. (8,15) Common sites of perforation are the sigmoid colon and caecum, and the rate of perforation in the left hemicolon is higher than that in the right due to the smaller diameter. (15) CRC that is associated with local abscess formation is rare, with a reported incidence rate of only 0.3%-4%.…”