Gastrointestinal perforation CT: Difference between revisions

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Latest revision as of 04:14, 4 February 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D [2]

Overview

Chest computed tomography (CT) is done when fluoroscopy is equivocal, and there is persisting suspicion of perforation. Signs of perforation on abdominal CT scanning include extraluminal oral contrast, free fluid or food collections, discontinuity of the intestinal wall, localized peritoneal fat stranding, and Bowel wall thickening.

Gastrointestinal perforation CT

Chest CT

Chest CT is done when fluoroscopy is equivocal, and there is persisting suspicion of perforation.
Signs of chest CT scanning include:^[1]
Pleural or mediastinal fluid
Pneumomediastinum or pneumothorax

Abdominal CT

Signs of perforation on abdominal CT scanning include:^[2]
Extraluminal oral contrast
Free fluid or food collections
Discontinuity of the intestinal wall
Localized peritoneal fat stranding
Bowel wall thickening
Fistula
Intra-abdominal abscess

Intestinal perforation CT, source: Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 47152

CT shows large bowel perforation, source: Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 55375

References

↑ Del Gaizo AJ, Lall C, Allen BC, Leyendecker JR (2014). "From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography". Abdom Imaging. 39 (4): 802–23. doi:10.1007/s00261-014-0110-4. PMID 24584681.
↑ Kim SW, Shin HC, Kim IY, Kim YT, Kim CJ (2010). "CT findings of colonic complications associated with colon cancer". Korean J Radiol. 11 (2): 211–21. doi:10.3348/kjr.2010.11.2.211. PMC 2827785. PMID 20191069.

[pmid24584681-1] Del Gaizo AJ, Lall C, Allen BC, Leyendecker JR (2014). "From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography". Abdom Imaging. 39 (4): 802–23. doi:10.1007/s00261-014-0110-4. PMID 24584681.

[pmid20191069-2] Kim SW, Shin HC, Kim IY, Kim YT, Kim CJ (2010). "CT findings of colonic complications associated with colon cancer". Korean J Radiol. 11 (2): 211–21. doi:10.3348/kjr.2010.11.2.211. PMC 2827785. PMID 20191069.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
-[{CMG}}; {{AE}} {{MAD}}
+{{CMG}}; {{AE}} {{MAD}}
+{{Gastrointestinal perforation}}
 ==Overview==
-Chest CT
+[[Chest]] [[computed tomography]] (CT) is done when [[fluoroscopy]] is equivocal, and there is persisting suspicion of perforation. Signs of perforation on abdominal [[Computed tomography|CT]] scanning include extraluminal oral contrast, free fluid or food collections, discontinuity of the intestinal wall, localized [[Peritoneum|peritoneal]] fat stranding, and [[Bowel]] wall thickening.
-Pneumothorax, pneumomediastinum, pleural effusion, mediastinal abscess.
-Abdominal CT
-Signs of perforation on abdominal CT scanning include extraluminal air (image 6); extraluminal oral contrast; free fluid or food collections; and discontinuity of the intestinal wall, fistula, or intra-abdominal abscess often associated with irregular adjacent bowel wall thickening [82,93,99,100].
-CT
-The role of CT is usually to look for stigmata of perforation when fluoroscopy is equivocal, and there is persisting suspicion of perforation. These include
-extraluminal gas locules in the mediastinum or abdominal cavity, adjacent to the esophagus are highly suggestive 2, 4
-pleural or mediastinal fluid
-pneumomediastinum or pneumothorax
-pericardial or pleural effusions can be seen Water soluble oral contrast can be administered 20 minutes before scanning to demonstrate extravasation. Intravenous contrast is usually administered to delineate the oesophageal wall (25 - 60-second delay) 8.
-CT
-this is the primary imaging modality for detection and localization of bowel perforation
-the site of the perforation can often be localized by:
-tracking the bubbles of pneumoperitoneum toward a region of the bowel
-looking for localized peritoneal fat stranding or bowel wall thickening o determining a site of bowel wall discontinuity
-if the patient received oral contrast, then often the leak can be seen directly as contrast spills out of the perforation site
-if a suspected bowel perforation is the primary indication for the study, then protocolling the study with a water-soluble contrast medium is useful
+==Gastrointestinal perforation CT==
+=== Chest CT ===
+* Chest CT is done when [[fluoroscopy]] is equivocal, and there is persisting suspicion of perforation.
+* Signs of chest [[Computed tomography|CT]] scanning include:<ref name="pmid24584681">{{cite journal| author=Del Gaizo AJ, Lall C, Allen BC, Leyendecker JR| title=From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography. | journal=Abdom Imaging | year= 2014 | volume= 39 | issue= 4 | pages= 802-23 | pmid=24584681 | doi=10.1007/s00261-014-0110-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24584681  }}</ref>
+* [[Pleural cavity|Pleural]] or [[Mediastinum|mediastinal]] fluid
+* [[Pneumomediastinum]] or [[pneumothorax]]
-if a bowel perforation occurs due to obstruction, the perforation usually occurs at the site of maximal bowel distention and the perforation may be distant from the actual cause of the bowel obstruction
+=== Abdominal CT ===
+* Signs of perforation on abdominal [[Computed tomography|CT]] scanning include:<ref name="pmid20191069">{{cite journal| author=Kim SW, Shin HC, Kim IY, Kim YT, Kim CJ| title=CT findings of colonic complications associated with colon cancer. | journal=Korean J Radiol | year= 2010 | volume= 11 | issue= 2 | pages= 211-21 | pmid=20191069 | doi=10.3348/kjr.2010.11.2.211 | pmc=2827785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20191069  }}</ref>
+* Extraluminal oral contrast
+* Free fluid or food collections
+* Discontinuity of the intestinal wall
+* Localized [[Peritoneum|peritoneal]] fat stranding
+* [[Bowel]] wall thickening
+* [[Fistula]]
+* Intra-abdominal [[abscess]]
-a bowel perforation may not result in pneumoperitoneum, but liquid contents exiting the bowel may form a phlegmon or abscess
+[[File:Peroration.gif.gif|center|300px|tumb|Intestinal perforation CT, source: Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 47152]]
+[[File:Large bowel perforation.gif.gif|center|300px|thumb|CT shows large bowel perforation, source: Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 55375]]
 ==References==
+{{Reflist|2}}